MEDICARE: CELSO DEL ANGEL MONTIEL HERNANDEZ SA-C

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	246ZC0007X	Surgical Assistant	22-267	TX

General Provider Information

NPI Number	:	1144093725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELSO DEL ANGEL MONTIEL HERNANDEZ SA-C

Provider Business Mailing Address
First Line	:	3832 GRAMERCY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1218
Country	:	US
Telephone Number	:	832-293-8090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3832 GRAMERCY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1218
Country	:	US
Telephone Number	:	832-293-8090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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