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NPI Code Detail

MEDICARE: MRS. UN SUK GILBERT LSA, CST/FA

MEDICARE: MRS. UN SUK GILBERT LSA, CST/FA
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
1246ZC0007XSurgical AssistantCERTIFICATE# 00F652TX
2246ZS0410XSurgical TechnologistSA00174TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10053LFOTHERTXBLUE CROSS BLUE SHIELD OF TEXAS

General Provider Information

NPI Number : 1174716450
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. UN SUK GILBERT LSA, CST/FA
Provider Business Mailing Address
First Line : 4400 INDIAN FALL DRIVE
Second Line :
City : PORT ARTHUR
State : TX
Zip : 77642
Country : US
Telephone Number : 409-293-1712
Fax Number : 409-963-1531
Provider Business Practice Location Address
First Line : 5500 39TH STREET
Second Line :
City : GROVES
State : TX
Zip : 77619-2905
Country : US
Telephone Number : 409-963-5265
Fax Number : 409-963-1531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 01/13/2011

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Directions to “ MRS. UN SUK GILBERT LSA, CST/FA” Practice Location

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