Provider Demographics
NPI:1639577885
Name:LA FUENTE PROSTHETICS
Entity Type:Organization
Organization Name:LA FUENTE PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRESTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-474-1620
Mailing Address - Street 1:229 N.W. 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102
Mailing Address - Country:US
Mailing Address - Phone:405-236-2882
Mailing Address - Fax:405-236-3335
Practice Address - Street 1:229 N.W. 9TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-236-2882
Practice Address - Fax:405-236-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier