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General NPI Number Information
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NPI Number | 1831561935
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Entity Type | Organization
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Legal Business Name | LONE STAR FIRST ASSISTANT SURGICAL SERVICES
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 21175 TOMBALL PKWY PMB # 122
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City | HOUSTON
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State | TX
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Zip | 77070-1655
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Country | US
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Telephone | 346-444-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 21175 TOMBALL PKWY PMB #122
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City | HOUSTON
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State | TX
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Zip | 77070-1655
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Country | US
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Telephone | 346-444-2705
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | DR. LUIS HERNANDEZ
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Credential | LSA
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Telephone | 281-256-5702
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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 | SA00334
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License Number State | TX
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