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General NPI Number Information
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NPI Number | 1730454539
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Entity Type | Individual
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Provider Name | THERESA MARIE HESLOP LSA, CSA
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Gender | Female
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 06/02/2017
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Provider Practice Location Address
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Address Line | 2437 BAY AREA BLVD
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City | HOUSTON
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State | TX
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Zip | 77058-1519
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Country | US
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Telephone | 832-891-9989
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Fax | 866-576-4221
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Provider Business Mailing Address
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Address Line | 2437 BAY AREA BLVD
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City | HOUSTON
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State | TX
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Zip | 77058-1519
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Country | US
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Telephone | 832-891-9989
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Fax | 866-576-4221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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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 | SA00475
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License Number State | TX
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Taxonomy #3
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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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