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NPI Code Detail

MEDICARE: ACE SURGICAL ASSISTANT

MEDICARE: ACE 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
1363AS0400XSurgical Physician AssistantSA00643TX

General Provider Information

NPI Number : 1871070151
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACE SURGICAL ASSISTANT
Provider Business Mailing Address
First Line : 3227 MULBERRY HILL LN
Second Line :
City : HOUSTON
State : TX
Zip : 77084-5525
Country : US
Telephone Number : 832-800-6798
Fax Number :
Provider Business Practice Location Address
First Line : 3227 MULBERRY HILL LN
Second Line :
City : HOUSTON
State : TX
Zip : 77084-5525
Country : US
Telephone Number : 832-800-6798
Fax Number :
Authorized Official
Title or Position : SURGICAL ASSISTANT
Name : MR. MARIO ARNOLDO RIVAS
Credential : LSA
Telephone Number : 832-800-6798
Provider Enumeration Date : 07/19/2018
Last Update Date : 08/17/2018

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Directions to “ACE SURGICAL ASSISTANT ” Practice Location

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