Provider Demographics
NPI:1851101307
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:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:OCULARIST
Authorized Official - Phone:405-620-0880
Mailing Address - Street 1:229 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2619
Mailing Address - Country:US
Mailing Address - Phone:405-620-0880
Mailing Address - Fax:
Practice Address - Street 1:229 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2619
Practice Address - Country:US
Practice Address - Phone:405-620-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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