Provider Demographics
NPI:1518157262
Name:PROSTHETIC ART SPECIALIST
Entity Type:Organization
Organization Name:PROSTHETIC ART SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-251-7974
Mailing Address - Street 1:7600 SW 136 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:786-251-7974
Mailing Address - Fax:
Practice Address - Street 1:14433 D DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-251-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment