Healthcare Provider Details

I. General information

NPI: 1508424169
Provider Name (Legal Business Name): HERITAGE SURGICAL ASSIST ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 WARREN PKWY STE 200
FRISCO TX
75034-7399
US

IV. Provider business mailing address

1141 N LOOP 1604 E #105-612
SAN ANTONIO TX
78232
US

V. Phone/Fax

Practice location:
  • Phone: 210-598-4262
  • Fax:
Mailing address:
  • Phone: 210-598-4262
  • Fax: 281-820-1901

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: ROXANNA LAROQUE
Title or Position: DIRECTOR OF CLIENT EXPERIENCE
Credential:
Phone: 210-598-2801