Provider Demographics
NPI:1528453768
Name:BASILISA SURGICAL ASSISTANT, LLC
Entity type:Organization
Organization Name:BASILISA SURGICAL ASSISTANT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:SALVADOR
Authorized Official - Last Name:LOPEZ CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-908-7831
Mailing Address - Street 1:330 RAYFORD RD STE 238
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1980
Mailing Address - Country:US
Mailing Address - Phone:832-908-7831
Mailing Address - Fax:
Practice Address - Street 1:25200 INTERSTATE 45 APT 104
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1414
Practice Address - Country:US
Practice Address - Phone:832-908-7831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty