MEDICARE: CARLOS PIRELA

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	SA00640	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA00640	OTHER	TX	LICENSE SURGICAL ASSISTANT

General Provider Information

NPI Number	:	1780077057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS PIRELA

Provider Business Mailing Address
First Line	:	15814 CHAMPION FOREST DR
Second Line	:	PMB 320
City	:	SPRING
State	:	TX
Zip	:	77379-7141
Country	:	US
Telephone Number	:	281-653-2924
Fax Number	:	832-478-9266

Provider Business Practice Location Address
First Line	:	15814 CHAMPION FOREST DR
Second Line	:	PMB 320
City	:	SPRING
State	:	TX
Zip	:	77379-7141
Country	:	US
Telephone Number	:	281-653-2924
Fax Number	:	832-478-9266

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/26/2018

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Directions to “ CARLOS PIRELA ” Practice Location

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