Provider Demographics
NPI:1659962074
Name:OB SURGICAL ASSISTANTS LLC
Entity Type:Organization
Organization Name:OB SURGICAL ASSISTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:O
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-805-4303
Mailing Address - Street 1:15411 HOPE SHADOW CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6237
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:15411 HOPE SHADOW CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6237
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty