Provider Demographics
NPI:1225588148
Name:SALLES BETANCOURT, GUIDO ROMAN (LSA)
Entity Type:Individual
Prefix:
First Name:GUIDO
Middle Name:ROMAN
Last Name:SALLES BETANCOURT
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16-499246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LH859OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX8KA698OtherBCBS - XCITE SURGICAL ASSISTANTS, LLC
TX8P793OtherBCBS - US MSO
TX8XP793OtherBCBS - US MSO
TXSA00644OtherTEXAS MEDICAL BOARD
TX8KA699OtherBCBS - UNIVERSAL SURGICAL PARTNERS, INC.
TX8KC697OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS, INC.