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General NPI Number Information
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NPI Number | 1962825109
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Entity Type | Organization
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Legal Business Name | STAR SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 941 MITCH THOMAS
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City | PLEASANTON
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State | TX
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Zip | 78064-4827
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Country | US
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Telephone | 210-863-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 941 MITCH THOMAS
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City | PLEASANTON
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State | TX
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Zip | 78064-4827
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Country | US
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Telephone | 210-863-8127
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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 | MR. ROGELIO GUARDIOLA JR.
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Credential | SA-C
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Telephone | 210-863-8127
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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 | 10-124
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License Number State | CO
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