Provider Demographics
NPI:1659795359
Name:PBP SURGICAL ASSIST LLC
Entity Type:Organization
Organization Name:PBP SURGICAL ASSIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-0077
Mailing Address - Street 1:12335 KINGSRIDE LN STE 275
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4116
Mailing Address - Country:US
Mailing Address - Phone:713-464-0077
Mailing Address - Fax:713-464-9582
Practice Address - Street 1:12335 KINGSRIDE LN STE 275
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4116
Practice Address - Country:US
Practice Address - Phone:713-464-0077
Practice Address - Fax:713-464-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty