Healthcare Provider Details

I. General information

NPI: 1578229407
Provider Name (Legal Business Name): PRECISION SURGICAL ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 SAINT MORITZ ST
BELLAIRE TX
77401-2617
US

IV. Provider business mailing address

5600 SAINT MORITZ ST
BELLAIRE TX
77401-2617
US

V. Phone/Fax

Practice location:
  • Phone: 832-646-8021
  • Fax:
Mailing address:
  • Phone: 832-646-8021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: GUILLERMO R FONSECA
Title or Position: OWNER
Credential: LSA, SA-C
Phone: 832-646-8021