MEDICARE: SYNERGISTIC SURGICAL ASSISTANT

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

General Provider Information

NPI Number	:	1356941652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGISTIC SURGICAL ASSISTANT

Provider Business Mailing Address
First Line	:	7414 BROOKPORT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7414 BROOKPORT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-3528
Country	:	US
Telephone Number	:	956-436-7243
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	ARACELY RODRIGUEZ
Credential	:	LSA
Telephone Number	:	214-227-2457

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	07/16/2024

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