Provider Demographics
NPI:1780077057
Name:PIRELA, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:PIRELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15814 CHAMPION FOREST DR
Mailing Address - Street 2:PMB 320
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7141
Mailing Address - Country:US
Mailing Address - Phone:281-653-2924
Mailing Address - Fax:832-478-9266
Practice Address - Street 1:15814 CHAMPION FOREST DR
Practice Address - Street 2:PMB 320
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7141
Practice Address - Country:US
Practice Address - Phone:281-653-2924
Practice Address - Fax:832-478-9266
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00640363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00640OtherLICENSE SURGICAL ASSISTANT