Provider Demographics
NPI:1417190372
Name:ALCOSEBA, EMMANUEL A (LSA)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:A
Last Name:ALCOSEBA
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 1:403 NEW HOPE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0285
Mailing Address - Country:US
Mailing Address - Phone:281-392-1936
Mailing Address - Fax:
Practice Address - Street 1:403 NEW HOPE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0285
Practice Address - Country:US
Practice Address - Phone:281-392-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06-174246ZS0410X
TXSA00381363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist