=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487004628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL FIRST ASSISTANTS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2016
-----------------------------------------------------
Last Update Date | 06/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3139 W HOLCOMBE BLVD # 284
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-372-6892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3139 W HOLCOMBE BLVD # 284
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-372-6892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | PATRICIA REYES
-----------------------------------------------------
Credential | CSFA
-----------------------------------------------------
Telephone | 832-372-6892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | 146297
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------