Organization
SUPERIOR PROSTHETICS & ORTHOTICS LLC
Active
Other names
Bacilio V. Moreno
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BACILIO V. MORENO SR. L.P. (LICENSED PROSTHETIST)
(210) 593-0953
Entity
Organization
Contact information
Practice address
7400 LOUIS PASTEUR, STE 202, SAN ANTONIO, TX 78229-4542
(210) 593-0953
(210) 593-0954
Mailing address
7400 LOUIS PASTEUR, STE 202, SAN ANTONIO, TX 78229-4542
(210) 593-0953
(210) 593-0954
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
428
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110058-01
—
TX
Enumeration date
04/26/2006
Last updated
12/09/2010
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