Individual
MR. EDGAR DE LA FUENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED PROSTHETIST
Contact information
Practice address
719 N. SECOND STREET, LONGVIEW, TX 75601-5316
(903) 553-1040
(903) 553-9996
Mailing address
719 N. SECOND STREET, LONGVIEW, TX 75601-5316
(903) 553-1040
(903) 553-9996
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
233
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168459901
—
TX
01
—
1750323713
NPI
TX
01
—
531976
BCBS OF TEXAS
TX
Enumeration date
06/12/2006
Last updated
04/17/2026
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