Provider Demographics
NPI:1902205446
Name:SYNERGY ORTHOPEDIC ASSISTING, LLC
Entity Type:Organization
Organization Name:SYNERGY ORTHOPEDIC ASSISTING, LLC
Other - Org Name:VAL LOPEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALENTIN
Authorized Official - Middle Name:VIDAL
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:210-872-0449
Mailing Address - Street 1:PO BOX 81603
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-1603
Mailing Address - Country:US
Mailing Address - Phone:512-973-9222
Mailing Address - Fax:512-777-4527
Practice Address - Street 1:1822 W BRAKER LN # 81603
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3606
Practice Address - Country:US
Practice Address - Phone:512-973-9222
Practice Address - Fax:512-777-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112413246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112413OtherCSFA CERTIFICATION