Healthcare Provider Details

I. General information

NPI: 1417190372
Provider Name (Legal Business Name): EMMANUEL A. ALCOSEBA LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 NEW HOPE LN
KATY TX
77494-0285
US

IV. Provider business mailing address

403 NEW HOPE LN
KATY TX
77494-0285
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-1936
  • Fax:
Mailing address:
  • Phone: 281-392-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number06-174
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00381
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: