# GULF COAST ORTHOTICS & PROSTHETICS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588087001
- **Authorized official:** MRS. LILLIANE M RODERIQUES (OWNER)
- **Authorized official phone:** (941) 408-6246

## Contact information

- **Practice address:** 21300 GERTRUDE AVE, PORT CHARLOTTE, FL 33952-5002
- **Practice address phone:** (941) 408-6246
- **Practice address fax:** (941) 249-8956
- **Mailing address:** 21300 GERTRUDE AVE, PORT CHARLOTTE, FL 33952-5002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | POR181 | FL | Yes |

## Other

- **Enumeration date:** 02/04/2014
- **Last updated:** 03/21/2014