Provider Demographics
NPI:1558698985
Name:RELIABLE SURGICAL ASSISTANCE, LLC
Entity Type:Organization
Organization Name:RELIABLE SURGICAL ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:281-463-6309
Mailing Address - Street 1:PO BOX 451722
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0042
Mailing Address - Country:US
Mailing Address - Phone:281-463-6309
Mailing Address - Fax:281-463-6835
Practice Address - Street 1:1627 SWEDEN LN
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8386
Practice Address - Country:US
Practice Address - Phone:281-463-6309
Practice Address - Fax:281-463-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00203363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty