Healthcare Provider Details

I. General information

NPI: 1306041280
Provider Name (Legal Business Name): SUGAR LAND SPINAL SOLUTIONS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 FOUNTAIN VIEW DR STE 101
HOUSTON TX
77057-4851
US

IV. Provider business mailing address

2411 FOUNTAIN VIEW DR STE 101
HOUSTON TX
77057-4851
US

V. Phone/Fax

Practice location:
  • Phone: 713-458-4601
  • Fax:
Mailing address:
  • Phone: 713-458-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE EDWARD BRETZ
Title or Position: GENERAL PARTNER
Credential:
Phone: 713-458-4601