Healthcare Provider Details

I. General information

NPI: 1104195932
Provider Name (Legal Business Name): MEJIA SURGICAL ASSISTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 ESSEN FRST
HELOTES TX
78023-3790
US

IV. Provider business mailing address

12902 ESSEN FRST
HELOTES TX
78023-3790
US

V. Phone/Fax

Practice location:
  • Phone: 210-683-4452
  • Fax:
Mailing address:
  • Phone: 210-683-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSE MIGUEL MEJIA JR.
Title or Position: CERTIFIED SURGICAL ASSISTANT
Credential:
Phone: 210-683-4452