Provider Demographics
NPI:1386068294
Name:SENTRY SURGICAL ASSISTANTS
Entity type:Organization
Organization Name:SENTRY SURGICAL ASSISTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT CERTIFIED
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C
Authorized Official - Phone:409-771-2237
Mailing Address - Street 1:12127 WORTHAM LANDING DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5212
Mailing Address - Country:US
Mailing Address - Phone:409-771-2237
Mailing Address - Fax:
Practice Address - Street 1:12127 WORTHAM LANDING DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5212
Practice Address - Country:US
Practice Address - Phone:409-771-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09-136246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty