MEDICARE: ROYAL SURGICAL ASSIST, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1023672193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL SURGICAL ASSIST, PLLC

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E #105-612
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232
Country	:	US
Telephone Number	:	210-598-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	9618 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1660
Country	:	US
Telephone Number	:	210-598-4262
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLIENT EXPERIENCE
Name	:	ROXANNA LAROQUE
Credential	:
Telephone Number	:	210-598-4262

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	08/19/2022

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