Organization
PHENOMSURGICAL ASSISTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN CHAMPION LSA (OWNER)
(510) 984-8610
Entity
Organization
Contact information
Practice address
4026 E TEAL ESTATES CIR, FRESNO, TX 77545-8851
(510) 984-8610
Mailing address
4026 E TEAL ESTATES CIR, FRESNO, TX 77545-8851
(510) 984-8610
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00547
TX
Other
Enumeration date
01/29/2016
Last updated
04/04/2016
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