Organization
EXPERIENCED SURGICAL ASSISTANCED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDUARDO ELIZONDO (AUTHORIZED OFFICIAL)
(281) 463-6309
Entity
Organization
Contact information
Practice address
24530 KINGSLAND BLVD, KATY, TX 77494-3429
(281) 463-6309
Mailing address
PO BOX 451722, LAREDO, TX 78045-0042
(281) 463-6309
(281) 463-6835
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
05/27/2016
Last updated
05/27/2016
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