Provider Demographics
NPI:1871070151
Name:ACE SURGICAL ASSISTANT
Entity type:Organization
Organization Name:ACE SURGICAL ASSISTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ARNOLDO
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:832-800-6798
Mailing Address - Street 1:3227 MULBERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5525
Mailing Address - Country:US
Mailing Address - Phone:832-800-6798
Mailing Address - Fax:
Practice Address - Street 1:3227 MULBERRY HILL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5525
Practice Address - Country:US
Practice Address - Phone:832-800-6798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00643363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherACE SURGICAL ASSISTANT