Organization
MIRROR IMAGE SURGICAL ASSISTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY LOVE LSA (OWNER)
(214) 227-2457
Entity
Organization
Contact information
Practice address
1417 JENNINGS CT, PROSPER, TX 75078-5018
(214) 227-2457
(214) 764-0880
Mailing address
PO BOX 2550, ROWLETT, TX 75030-2550
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
03/03/2021
Last updated
07/08/2022
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