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Organization

ELITE PA SURGICAL ASSISTS, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAULINA PURNAMA PA-C (OWNER)
(469) 708-3989
Entity
Organization

Contact information

Practice address
2600 E SOUTHLAKE BLVD STE 120-177, SOUTHLAKE, TX 76092-6634
(469) 708-3989
Mailing address
2600 E SOUTHLAKE BLVD STE 120-177, SOUTHLAKE, TX 76092-6634
(469) 708-3989

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
TX11021
TX

Other

Enumeration date
08/29/2017
Last updated
01/31/2025
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