Provider Demographics
NPI:1710455522
Name:JL SURGICAL ASSISTING
Entity Type:Organization
Organization Name:JL SURGICAL ASSISTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:210-204-7728
Mailing Address - Street 1:7919 ABBOTTS POINTE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5478
Mailing Address - Country:US
Mailing Address - Phone:210-204-7728
Mailing Address - Fax:
Practice Address - Street 1:7919 ABBOTTS POINTE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5478
Practice Address - Country:US
Practice Address - Phone:210-204-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13507539OtherCAQH
TX14-9444OtherNBSTSA