Provider Demographics
NPI:1659994184
Name:PROSTHETIC INNOVATIONS INC
Entity Type:Organization
Organization Name:PROSTHETIC INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-222-9805
Mailing Address - Street 1:2300 W SAMPLE RD STE 314
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3030
Mailing Address - Country:US
Mailing Address - Phone:754-222-9805
Mailing Address - Fax:
Practice Address - Street 1:2300 W SAMPLE RD STE 314
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3030
Practice Address - Country:US
Practice Address - Phone:305-985-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier