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General NPI Number Information
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NPI Number | 1487166047
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Entity Type | Organization
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Legal Business Name | ALC SURGICAL ASSISTING, LLC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 2909 PAWTUCKET RD
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City | CIBOLO
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State | TX
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Zip | 78108-2414
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Country | US
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Telephone | 210-965-3505
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Fax | 210-233-6794
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Provider Business Mailing Address
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Address Line | 2909 PAWTUCKET RD
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City | CIBOLO
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State | TX
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Zip | 78108-2414
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Country | US
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Telephone | 210-965-3505
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Fax | 210-233-6794
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Authorized Official
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Title or Position | MANAGER
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Name | ALEJANDRO LUNA-CABRERA
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Credential | LSA
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Telephone | 210-965-3505
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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 | SA00539
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License Number State | TX
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