MR. EDGAR DE LA FUENTE LICENSED PROSTHETIST NPI 1750323713

NPI Information

NPI: 1750323713
Provider Name: MR. EDGAR DE LA FUENTE, LICENSED PROSTHETIST
Classification: Prosthetic/Orthotic Supplier - 335E00000X
Entity Type: Individual
Address:
719 N. SECOND STREET
LONGVIEW, TX
ZIP 75601
Phone: (903) 553-1040
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MR. Edgar De La Fuente, LICENSED PROSTHETIST is a prosthetic orthotic supplier in Longview, TX. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. MR. Edgar De La Fuente, LICENSED PROSTHETIST NPI is 1750323713. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

719 N. SECOND STREET
LONGVIEW, TX
ZIP 75601-316
Phone: (903) 553-1040
Fax: (903) 553-9996

The enumeration date for this NPI number is 6/12/2006 and was last updated on 3/18/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	335E00000X	Prosthetic/Orthotic Supplier		233	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1750323713	OTHER	TEXAS	NPI
2	531976	OTHER	TEXAS	BCBS OF TEXAS
3	5063190001	MEDICARE NSC	TEXAS
4	168459901	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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