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General NPI Number Information
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NPI Number | 1376882506
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Entity Type | Organization
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Legal Business Name | INNOVATIVE SURGICAL AFFILIATE
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 3810 LAW # 234
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City | HOUSTON
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State | TX
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Zip | 77005-1171
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Country | US
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Telephone | 832-390-1082
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Fax | 832-610-3690
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Provider Business Mailing Address
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Address Line | 3810 LAW # 234
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City | HOUSTON
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State | TX
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Zip | 77005-1171
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Country | US
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Telephone | 832-390-1082
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Fax | 832-610-3690
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Authorized Official
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Title or Position | SA-C/ SURGICAL ASSISTANT
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Name | ELIN ALLEN YU
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Credential |
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Telephone | 832-390-1082
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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 | 11-100
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License Number State | TX
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