Healthcare Provider Details

I. General information

NPI: 1972180966
Provider Name (Legal Business Name): SURGICAL SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 NORTHWIND DR
EL PASO TX
79912-3712
US

IV. Provider business mailing address

232 NORTHWIND DR
EL PASO TX
79912-3712
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: RAUL MUNOZ
Title or Position: MEMBER
Credential: LSA
Phone: 214-227-2457