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General NPI Number Information
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NPI Number | 1235569906
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Entity Type | Organization
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Legal Business Name | PASADENA SURGICAL ASSISTANT
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 2607 DIXIE WOODS DR
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City | PEARLAND
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State | TX
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Zip | 77581-5896
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Country | US
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Telephone | 832-406-2427
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34292
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City | HOUSTON
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State | TX
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Zip | 77234-4292
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Country | US
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Telephone | 832-406-2427
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM HERNANDEZ HERNANDEZ
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Credential | LSA
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Telephone | 832-406-2427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00448
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License Number State | TX
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