Provider Demographics
NPI:1255874178
Name:CORREA SURGICAL ASSISTANTS, LLC
Entity type:Organization
Organization Name:CORREA SURGICAL ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:713-614-4465
Mailing Address - Street 1:8022 OXBOW MANOR LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-0162
Mailing Address - Country:US
Mailing Address - Phone:713-614-4465
Mailing Address - Fax:832-674-7284
Practice Address - Street 1:8022 OXBOW MANOR LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-0162
Practice Address - Country:US
Practice Address - Phone:713-614-4465
Practice Address - Fax:832-674-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00168363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty