Provider Demographics
NPI:1275091332
Name:PROFESSIONAL SURGICAL ASSISTANT SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL SURGICAL ASSISTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLATORO
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-812-8342
Mailing Address - Street 1:PO BOX 840355
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77284-0355
Mailing Address - Country:US
Mailing Address - Phone:832-812-8342
Mailing Address - Fax:
Practice Address - Street 1:1 SUGAR CREEK BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8SQ944OtherXCITE SURGICAL
TX8SY054OtherBLUE STAR SURGICAL ASSISTANTS
TX8SQ944OtherUNIVERSAL SURGICAL ASSISTANTS
TX8SY135OtherUS MSO