Provider Demographics
NPI:1265033252
Name:DAEVA SURGICAL LIMITED LIABILITY
Entity Type:Organization
Organization Name:DAEVA SURGICAL LIMITED LIABILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-493-0969
Mailing Address - Street 1:11126 CHELSEA OAK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5478
Mailing Address - Country:US
Mailing Address - Phone:832-384-8910
Mailing Address - Fax:832-575-4762
Practice Address - Street 1:11126 CHELSEA OAK ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5478
Practice Address - Country:US
Practice Address - Phone:832-384-8910
Practice Address - Fax:832-575-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty