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General NPI Number Information
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NPI Number | 1972806305
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL CENTER FOR SURGICAL SCIENCE
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 10005 S MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77025-5209
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Country | US
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Telephone | 281-833-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 10005 S MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77025-5209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DIANA AYALA
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Credential |
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Telephone | 281-743-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 130064
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License Number State | TX
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