Provider Demographics
NPI:1992232789
Name:EL PASO PROSTHETIC CENTER, LLC
Entity type:Organization
Organization Name:EL PASO PROSTHETIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ-SANTULLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-904-0408
Mailing Address - Street 1:1800 N MESA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N MESA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3553
Practice Address - Country:US
Practice Address - Phone:915-234-2408
Practice Address - Fax:915-260-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier