Provider Demographics
NPI:1770621922
Name:ABANA ORTHOTICS & PROSTHETICS INC
Entity type:Organization
Organization Name:ABANA ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:SALIM
Authorized Official - Last Name:LUTFALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, BOCPO, CPED
Authorized Official - Phone:318-767-1929
Mailing Address - Street 1:1419 PETERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3433
Mailing Address - Country:US
Mailing Address - Phone:318-767-1929
Mailing Address - Fax:318-767-1385
Practice Address - Street 1:1419 PETERMAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3433
Practice Address - Country:US
Practice Address - Phone:318-767-1929
Practice Address - Fax:318-767-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106194Medicaid
LAG0568OtherBCBS OF LOUISIANA
LA1106194Medicaid