Provider Demographics
NPI:1275954729
Name:FRIAS, XUAN SUSIE (LSA)
Entity Type:Individual
Prefix:MS
First Name:XUAN
Middle Name:SUSIE
Last Name:FRIAS
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:MRS
Other - First Name:XUAN
Other - Middle Name:THI
Other - Last Name:FRIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSA
Mailing Address - Street 1:PO BOX 20344
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0344
Mailing Address - Country:US
Mailing Address - Phone:713-806-1930
Mailing Address - Fax:713-456-2025
Practice Address - Street 1:13605 SUMMER CLOUD LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2164
Practice Address - Country:US
Practice Address - Phone:713-806-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00757363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4188OtherTEXAS MEDICAL BOARD