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General NPI Number Information
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NPI Number | 1760087431
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Entity Type | Organization
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Legal Business Name | ASTUDILLO SURGICAL ASSISTANT LLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 18006 ISELT CT
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City | TOMBALL
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State | TX
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Zip | 77377-2378
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Country | US
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Telephone | 281-653-2924
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Fax | 832-478-9266
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Provider Business Mailing Address
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Address Line | 18006 ISELT CT
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City | TOMBALL
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State | TX
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Zip | 77377-2378
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Country | US
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Telephone | 281-653-2924
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Fax | 832-478-9266
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Authorized Official
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Title or Position | OWNER
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Name | HECTOR ASTUDILLO MANTILLA
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Credential | LSA
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Telephone | 201-892-8009
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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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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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