Healthcare Provider Details

I. General information

NPI: 1588150056
Provider Name (Legal Business Name): PROFICIENT SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2018
Last Update Date: 07/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 CREEK DR
HOUSTON TX
77080-6820
US

IV. Provider business mailing address

1823 CREEK DR
HOUSTON TX
77080-6820
US

V. Phone/Fax

Practice location:
  • Phone: 281-935-2012
  • Fax:
Mailing address:
  • Phone: 281-935-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number903329
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00324
License Number StateTX

VIII. Authorized Official

Name: JULIO C LORES RIVERON
Title or Position: MANAGER
Credential: CLSA, CSA LSA, RN
Phone: 281-818-7984