MEDICARE: MS. THERESA L SWEET CSFA

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	122709	TX

General Provider Information

NPI Number	:	1356351324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. THERESA L SWEET CSFA

Provider Business Mailing Address
First Line	:	2414 SUNSET BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1432
Country	:	US
Telephone Number	:	713-521-2414
Fax Number	:	832-413-5404

Provider Business Practice Location Address
First Line	:	2414 SUNSET BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1432
Country	:	US
Telephone Number	:	713-521-2414
Fax Number	:	832-413-5404

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/01/2010

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