Provider Demographics
NPI:1154652550
Name:ELITE SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:ELITE SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:281-748-5042
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1001
Mailing Address - Country:US
Mailing Address - Phone:832-559-1523
Mailing Address - Fax:281-668-6374
Practice Address - Street 1:12323 PINEY BEND DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-7853
Practice Address - Country:US
Practice Address - Phone:832-559-1523
Practice Address - Fax:281-668-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00202363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty