Organization
PANPLASTICITY HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDGAR FRAGOSO (AUTHORIZED OFFICIAL)
(281) 463-6309
Entity
Organization
Contact information
Practice address
1300 CASTLE CT, HOUSTON, TX 77006-5702
(281) 463-6309
Mailing address
PO BOX 1144, DEPT 1000, HOUSTON, TX 77251-1144
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
08/19/2014
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