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General NPI Number Information
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NPI Number | 1497850648
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Entity Type | Organization
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Legal Business Name | BAYSIDE A S C LP
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 4001 PRESTON AVE STE 175
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City | PASADENA
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State | TX
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Zip | 77505-2019
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Country | US
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Telephone | 281-487-6111
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Fax | 281-487-6090
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Provider Business Mailing Address
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Address Line | 4001 PRESTON AVE STE 175
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City | PASADENA
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State | TX
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Zip | 77505-2019
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Country | US
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Telephone | 281-487-6111
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Fax | 281-487-6090
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Authorized Official
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Title or Position | GENERAL PATNER
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Name | JORGE RODRIGUEZ
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Credential | M.D.
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Telephone | 281-487-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008204
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License Number State | TX
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