MEDICARE: MS. MARIA E. GOEN LSA

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	SA00389	TX

General Provider Information

NPI Number	:	1407082357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA E. GOEN LSA

Provider Business Mailing Address
First Line	:	3808 LAKE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-5524
Country	:	US
Telephone Number	:	713-898-5449
Fax Number	:	832-681-9050

Provider Business Practice Location Address
First Line	:	3808 LAKE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-5524
Country	:	US
Telephone Number	:	713-850-0870
Fax Number	:	832-681-9050

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

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	11/08/2017

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