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General NPI Number Information
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NPI Number | 1417861790
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Entity Type | Organization
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Legal Business Name | DMV G-ANGEL SURGICAL ASSIST LLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 2453 KENBROOK CT
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City | WALDORF
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State | MD
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Zip | 20603-3227
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Country | US
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Telephone | 301-257-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 2453 KENBROOK CT
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City | WALDORF
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State | MD
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Zip | 20603-3227
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Country | US
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Telephone | 301-257-6191
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND MANAGING MEMBER
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Name | MR. JACQUES EMILE BUSSIERE
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Credential | LSA, CSA
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Telephone | 301-257-6191
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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 | NULL
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