Provider Demographics
NPI:1750059077
Name:SOUTH TEXAS SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEROEL
Authorized Official - Suffix:
Authorized Official - Credentials:CST, CSFA, LSA
Authorized Official - Phone:210-324-2550
Mailing Address - Street 1:7934 VISHAL DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2176
Mailing Address - Country:US
Mailing Address - Phone:210-324-2550
Mailing Address - Fax:
Practice Address - Street 1:7934 VISHAL DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2176
Practice Address - Country:US
Practice Address - Phone:210-324-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty