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General NPI Number Information
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NPI Number | 1588150056
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Entity Type | Organization
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Legal Business Name | PROFICIENT SURGICAL SERVICES LLC
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Dates
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Enumeration Date | 07/07/2018
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Last Update Date | 07/07/2018
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Provider Practice Location Address
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Address Line | 1823 CREEK DR
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City | HOUSTON
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State | TX
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Zip | 77080-6820
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Country | US
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Telephone | 281-935-2012
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Fax |
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Provider Business Mailing Address
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Address Line | 1823 CREEK DR
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City | HOUSTON
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State | TX
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Zip | 77080-6820
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Country | US
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Telephone | 281-935-2012
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JULIO C LORES RIVERON
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Credential | CLSA, CSA LSA, RN
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Telephone | 281-818-7984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 903329
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA00324
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License Number State | TX
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