Organization
CUSTOM ORTHOTICS & PROSTHETICS, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANETTE CALDERON (PRACTICE MANAGER)
(915) 566-3440
Entity
Organization
Contact information
Practice address
3901 MONTANA AVE STE C, EL PASO, TX 79903-4507
(915) 566-3440
(915) 566-1485
Mailing address
3901 MONTANA AVE STE C, EL PASO, TX 79903-4507
(915) 566-3440
(915) 566-1485
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
335E00000X
Prosthetic/Orthotic Supplier
101202
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101202
TX O&P FACILITY STATE LIC
TX
05
—
178724401
—
TX
05
—
178724404
—
TX
05
—
178724405
—
TX
05
—
178724406
—
TX
05
—
178724407
—
TX
Enumeration date
10/27/2006
Last updated
06/12/2024
Update your record
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