Provider Demographics
NPI:1790595254
Name:LA FUENTE SPECIALTY PROSTHETICS,LLC
Entity type:Organization
Organization Name:LA FUENTE SPECIALTY PROSTHETICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCUARIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-620-0880
Mailing Address - Street 1:214 E LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6440
Mailing Address - Country:US
Mailing Address - Phone:405-620-0880
Mailing Address - Fax:
Practice Address - Street 1:214 E LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6440
Practice Address - Country:US
Practice Address - Phone:405-620-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA FUENTE SPECIALTY PROSTHETICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment