Healthcare Provider Details

I. General information

NPI: 1447667464
Provider Name (Legal Business Name): MGFG SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 KARLE RD
ROSENBERG TX
77471-9564
US

IV. Provider business mailing address

2119 KARLE RD
ROSENBERG TX
77471-9564
US

V. Phone/Fax

Practice location:
  • Phone: 832-630-0772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number06-115
License Number StateTX

VIII. Authorized Official

Name: FLOR GONZALEZ
Title or Position: SURGICAL ASSISTANT-CERTIFIED
Credential:
Phone: 832-630-0772