Healthcare Provider Details

I. General information

NPI: 1841444940
Provider Name (Legal Business Name): ELIAS YARRITO JR. CSA/LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUGAR CREEK CENTER BLVD STE 618
SUGAR LAND TX
77478-3540
US

IV. Provider business mailing address

118 AXLEWOOD CT
MONTGOMERY TX
77316-1853
US

V. Phone/Fax

Practice location:
  • Phone: 832-655-4141
  • Fax:
Mailing address:
  • Phone: 936-760-6591
  • Fax: 936-582-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: