Provider Demographics
NPI:1043220890
Name:PASADENA SURGICAL ASSOCIATION
Entity Type:Organization
Organization Name:PASADENA SURGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:713-477-2283
Mailing Address - Street 1:908 SOUTHMORE AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-1134
Mailing Address - Country:US
Mailing Address - Phone:713-477-2283
Mailing Address - Fax:713-475-5986
Practice Address - Street 1:908 SOUTHMORE AVE
Practice Address - Street 2:STE 270
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-1134
Practice Address - Country:US
Practice Address - Phone:713-477-2283
Practice Address - Fax:713-475-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085455601Medicaid