Provider Demographics
NPI:1891930103
Name:SAN ANTONIO ORTHOTICS CORPORATION
Entity Type:Organization
Organization Name:SAN ANTONIO ORTHOTICS CORPORATION
Other - Org Name:NUECES PROSTHETICS & ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LO, BOCO, CO
Authorized Official - Phone:210-614-8777
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:STE. 150
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-614-8777
Mailing Address - Fax:
Practice Address - Street 1:2222 MORGAN AVE
Practice Address - Street 2:STE. 115
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1948
Practice Address - Country:US
Practice Address - Phone:210-496-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier