Provider Demographics
NPI:1669728572
Name:PROTEAN SURGICAL ASSISTANTS PLLC
Entity type:Organization
Organization Name:PROTEAN SURGICAL ASSISTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUNGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:713-501-5545
Mailing Address - Street 1:PO BOX 451669
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77245-1669
Mailing Address - Country:US
Mailing Address - Phone:713-501-5545
Mailing Address - Fax:713-436-9066
Practice Address - Street 1:11710 SHOAL LANDING ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8750
Practice Address - Country:US
Practice Address - Phone:713-501-5545
Practice Address - Fax:713-436-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-28
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711650163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty