Healthcare Provider Details

I. General information

NPI: 1225158918
Provider Name (Legal Business Name): MASOUDA MAYOR LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 NORTHCREST VILLAGE WAY
SPRING TX
77388-6921
US

IV. Provider business mailing address

6131 NORTHCREST VILLAGE WAY
SPRING TX
77388-6921
US

V. Phone/Fax

Practice location:
  • Phone: 346-369-5198
  • Fax:
Mailing address:
  • Phone: 346-369-5198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00296
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number03-139
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberSA00296
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA00296
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: