MEDICARE: NELSON MOBAK L.P.

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	363AS0400X	Surgical Physician Assistant	SA00083	TX

General Provider Information

NPI Number	:	1164544318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELSON MOBAK L.P.

Provider Business Mailing Address
First Line	:	PO BOX 16548
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77496-6548
Country	:	US
Telephone Number	:	832-704-3911
Fax Number	:	281-207-5484

Provider Business Practice Location Address
First Line	:	19901 SOUTHWEST FWY
Second Line	:	SUITE #134
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-6538
Country	:	US
Telephone Number	:	832-704-3911
Fax Number	:	281-207-5484

Authorized Official
Title or Position	:	CERTIFIED SURGICAL ASSISTANT
Name	:	MR. ESTUARDO MOTA
Credential	:	SA
Telephone Number	:	832-704-3911

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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