Provider Demographics
NPI:1023528015
Name:PROSTHETIC TECHNOLOGY CENTER, INC
Entity type:Organization
Organization Name:PROSTHETIC TECHNOLOGY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LIBER
Authorized Official - Last Name:MOSQUERA CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:CP/LP
Authorized Official - Phone:562-373-8667
Mailing Address - Street 1:9069 W 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1883
Mailing Address - Country:US
Mailing Address - Phone:562-373-8667
Mailing Address - Fax:844-828-8593
Practice Address - Street 1:7254 BLANCO RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4930
Practice Address - Country:US
Practice Address - Phone:210-600-9884
Practice Address - Fax:210-600-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1774224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty