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General NPI Number Information
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NPI Number | 1649437773
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Entity Type | Organization
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Legal Business Name | ADVANCED ASSISTANT SURGERY, PLLC
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 14027 MEMORIAL DR STE 120
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City | HOUSTON
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State | TX
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Zip | 77079-6826
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Country | US
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Telephone | 832-863-2057
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Fax | 281-558-2756
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Provider Business Mailing Address
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Address Line | 14027 MEMORIAL DR STE 120
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City | HOUSTON
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State | TX
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Zip | 77079-6826
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Country | US
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Telephone | 832-863-2057
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Fax | 281-558-2756
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Authorized Official
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Title or Position | OWNER
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Name | MARICELA HERNANDEZ
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Credential | LSA
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Telephone | 832-863-2057
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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 | SA00244
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License Number State | TX
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