Organization
360 SURGICAL ASSISTING OF CENTRAL TEXAS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERIBERTO BOLANOS (CERTIFIED SURGICAL FIRST ASSISTANT)
(512) 644-1931
Entity
Organization
Contact information
Practice address
901 W BEN WHITE BLVD, AUSTIN, TX 78704-6903
(512) 447-2211
Mailing address
2950 E OLD SETTLERS BLVD UNIT 30, ROUND ROCK, TX 78665-2478
(512) 644-1931
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
02/15/2022
Last updated
02/15/2022
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