Provider Demographics
NPI:1144746561
Name:LONE STAR NEUROSURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:LONE STAR NEUROSURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDOLREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIADATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-878-4021
Mailing Address - Street 1:1270 CASA BELLA CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1270 CASA BELLA CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:469-878-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty