Organization
CONCOURSE ORTHOTIC AND PROSTHETIC LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALTAGRACIA N PENA CP (MANAGER)
(305) 362-6962
Entity
Organization
Contact information
Practice address
3750 W 16TH AVE, SUITE 404, HIALEAH, FL 33012-4654
(305) 362-6962
(305) 362-4424
Mailing address
3750 W 16TH AVE, SUITE 404, HIALEAH, FL 33012-4654
(305) 362-6962
(305) 362-4424
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
08/14/2006
Last updated
08/22/2020
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