Organization
MEDICAL PROSTHETIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS DANIEL PONTON COF (CEO)
(787) 359-4770
Entity
Organization
Contact information
Practice address
EBANO 74 MONTECASINO, TOA ALTA, PR 00953
(787) 359-4770
(787) 359-4770
Mailing address
EBANO 74 MONTECASINO, TOA ALTA, PR 00953
(787) 359-4770
(787) 359-4770
Taxonomy
Speciality
Code
Description
License number
State
261QA0900X
Amputee Clinic/Center
Primary
—
—
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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