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General NPI Number Information
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NPI Number | 1154854586
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Entity Type | Organization
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Legal Business Name | ELITE SURGICAL ASSISTING OF SOUTH TEXAS
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 04/04/2017
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Provider Practice Location Address
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Address Line | 10914 STAGWOOD PASS
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City | SAN ANTONIO
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State | TX
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Zip | 78254-5344
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Country | US
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Telephone | 210-273-0045
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Fax |
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Provider Business Mailing Address
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Address Line | 10914 STAGWOOD PASS
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City | SAN ANTONIO
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State | TX
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Zip | 78254-5344
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Country | US
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Telephone | 210-273-0045
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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 | MR. JASON DONALD MARTINEZ
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Credential | CSFA
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Telephone | 210-273-0045
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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 | 143032
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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