MEDICARE: SURGICAL FIRST ASSISTANT SERVICES

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	C07-0129A	TX

General Provider Information

NPI Number	:	1902048549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL FIRST ASSISTANT SERVICES

Provider Business Mailing Address
First Line	:	519 DAWNVIEW LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-3647
Country	:	US
Telephone Number	:	210-464-3902
Fax Number	:	210-320-6121

Provider Business Practice Location Address
First Line	:	519 DAWNVIEW LN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-3647
Country	:	US
Telephone Number	:	210-464-3902
Fax Number	:	210-320-6121

Authorized Official
Title or Position	:	CERTIFIED ASSISTANT AT SURGERY
Name	:	MR. ANTONIO CABRIALES
Credential	:	CST/AS-C
Telephone Number	:	210-464-3902

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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Directions to “SURGICAL FIRST ASSISTANT SERVICES ” Practice Location

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