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General NPI Number Information
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NPI Number | 1942700968
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Entity Type | Organization
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Legal Business Name | FASA, LLC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 2840 BUSINESS LOOP 181 N STE 170
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City | FLORESVILLE
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State | TX
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Zip | 78114-6665
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Country | US
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Telephone | 281-685-3669
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Fax | 888-979-8450
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Provider Business Mailing Address
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Address Line | 2840 BUSINESS LOOP 181 N STE 170
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City | FLORESVILLE
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State | TX
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Zip | 78114-6665
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Country | US
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Telephone | 281-685-3669
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MERYL YACKEL
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Credential |
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Telephone | 281-685-3669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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