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General NPI Number Information
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NPI Number | 1518360106
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Entity Type | Organization
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Legal Business Name | JAC SURGICAL ASSISTANTS LLC
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 15515 CLEAR VALLEY DR
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City | HOUSTON
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State | TX
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Zip | 77095-2774
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Country | US
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Telephone | 713-614-4465
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Fax | 832-674-7284
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Provider Business Mailing Address
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Address Line | 6031 HIGHWAY 6 N SUITE 165 # 155
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City | HOUSTON
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State | TX
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Zip | 77084-2584
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Country | US
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Telephone | 713-614-4465
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Fax | 832-674-7284
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Authorized Official
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Title or Position | OWNER
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Name | JORGE ALFONSO CORREA
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Credential | L.S.A.
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Telephone | 713-614-4465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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