# ORTHOTIC & PROSTHETIC CLINIC OF JACKSONVILLE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ORTHOTIC & PROSTHETIC CLINICS OF AMERICA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942067939
- **Authorized official:** MR. RAFAEL AGUSTIN DIAZ ABREU (OWNER / AMBR)
- **Authorized official phone:** (305) 812-5087

## Contact information

- **Practice address:** 11512 LAKE MEAD AVE UNIT 404, JACKSONVILLE, FL 32256-9687
- **Practice address phone:** (904) 231-8440
- **Practice address fax:** (904) 231-8441
- **Mailing address:** 2754 NW 27TH AVE, BOCA RATON, FL 33434-3692
- **Mailing address phone:** (305) 812-5087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 03/05/2024
- **Last updated:** 03/05/2024