De La Fuente, Edgar

De La Fuente, Edgar is an sole proprietor health care provider with primary practice located at 719 N. Second Street , Longview TX 75601-5316. He recently has only one registered license in Suppliers / Prosthetic/Orthotic Supplier, which is considered as his primary health care specialty. De La Fuente, Edgar can be contacted via phone (903) 553-1040.

Contact Information

Primary practice address
719 N. Second Street Longview TX 75601-5316
Phone: (903) 553-1040
Fax: (903) 553-9996
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Prosthetic/Orthotic Supplier 335E00000X 233 Texas

Profile Details

NPI number 1750323713
LBN Legal business name De La Fuente, Edgar
Credentials LICENSED PROSTHETIST
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 12th, 2006
Last updated Mar 18th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750323713 NPPES
Texas Other 1750323713 NPI
Texas Other 531976 NPI
Texas MEDICAID 168459901 NPI

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