Provider Demographics
NPI:1831847458
Name:ELITE COASTAL SURGICAL ASSIST
Entity type:Organization
Organization Name:ELITE COASTAL SURGICAL ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LEANDRA
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:361-222-2144
Mailing Address - Street 1:449 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-2518
Mailing Address - Country:US
Mailing Address - Phone:361-222-2144
Mailing Address - Fax:
Practice Address - Street 1:449 E ELM ST
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-2518
Practice Address - Country:US
Practice Address - Phone:361-222-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty