Provider Demographics
NPI:1275066227
Name:LACEY L. AGUERO
Entity Type:Organization
Organization Name:LACEY L. AGUERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:AGUERO
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:210-639-3353
Mailing Address - Street 1:6407 COUGAR VLG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78242-2466
Mailing Address - Country:US
Mailing Address - Phone:210-639-3112
Mailing Address - Fax:210-233-8672
Practice Address - Street 1:6407 COUGAR VLG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78242-2466
Practice Address - Country:US
Practice Address - Phone:210-639-3353
Practice Address - Fax:210-233-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00674OtherTEXAS MEDICAL BOARD