Organization
SHOE SPECIALISTS OF LAREDO & MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SAN JUANITA MARTINEZ SHOE FITTER (SHOE FITTER)
(956) 775-7832
Entity
Organization
Contact information
Practice address
517 SHILOH DR, STE4, LAREDO, TX 78045-6722
(956) 508-7666
Mailing address
517 SHILOH DR, STE4, LAREDO, TX 78045-6722
(956) 508-7666
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
32021418402
TX
Other
Enumeration date
03/17/2010
Last updated
01/11/2011
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