Individual
EDGARDO A SEQUEIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA, CSFA
Contact information
Practice address
121 TUSCANY DR, GEORGETOWN, TX 78628-7066
(818) 471-5979
Mailing address
121 TUSCANY DR, GEORGETOWN, TX 78628-7066
(818) 471-5979
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00736
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178570
NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING
TX
01
—
SA00736
SURGICAL ASSISTANT LICENSE
TX
Enumeration date
08/16/2019
Last updated
08/16/2019
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