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General NPI Number Information
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NPI Number | 1083026389
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Entity Type | Organization
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Legal Business Name | LDLC- SURGICAL ASSISTANTS, LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 218 MACKEY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78213-4453
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Country | US
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Telephone | 210-218-2902
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Fax | 210-236-9621
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Provider Business Mailing Address
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Address Line | 218 MACKEY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78213-4453
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFIED SURGICAL FIRST ASSISTANT
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Name | LARRY DE LA CRUZ
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Credential |
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Telephone | 210-218-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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