Provider Demographics
NPI:1497392120
Name:FOUNDATION SURGICAL ASSIST, PLLC
Entity Type:Organization
Organization Name:FOUNDATION SURGICAL ASSIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLIENT EXPERIENCE
Authorized Official - Prefix:
Authorized Official - First Name:ROZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-598-4277
Mailing Address - Street 1:1141 N LOOP 1604 E #105-612
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-598-4262
Mailing Address - Fax:
Practice Address - Street 1:1125 RAIN TREE CIRCLE STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:210-598-4262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty