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General NPI Number Information
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NPI Number | 1295158475
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Entity Type | Organization
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Legal Business Name | JB SURGICAL ASSIST LLC
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 8829 MERLIN DRIVE
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City | HOUSTON
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State | TX
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Zip | 77055
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Country | US
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Telephone | 713-984-9918
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Fax |
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Provider Business Mailing Address
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Address Line | 8829 MERLIN DRIVE
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City | HOUSTON
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State | TX
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Zip | 77055
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Country | US
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Telephone | 713-984-9918
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUAN CARLOS BUSTOS
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Credential | MD
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Telephone | 713-984-9918
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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 | SA00382
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License Number State | TX
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