# TRI-STATE SURGICAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356622583
- **Authorized official:** CARLOS MEZA-VALENCIA C-SA (OWNER, PRESIDENT)
- **Authorized official phone:** (571) 244-4684

## Contact information

- **Practice address:** 10332 MAIN ST \# 344, FAIRFAX, VA 22030-2410
- **Practice address phone:** (571) 244-4684
- **Mailing address:** 10332 MAIN ST \# 344, FAIRFAX, VA 22030-2410
- **Mailing address phone:** (571) 244-4684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2011
- **Last updated:** 02/22/2014