Provider Demographics
NPI:1811182322
Name:PACIFIC SURGICAL LC
Entity type:Organization
Organization Name:PACIFIC SURGICAL LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ESTUARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOTA
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:832-704-3911
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0037
Mailing Address - Country:US
Mailing Address - Phone:832-704-3911
Mailing Address - Fax:281-207-5484
Practice Address - Street 1:19901 SOUTH WEST FREEWAY
Practice Address - Street 2:
Practice Address - City:SUGARLAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:832-704-3911
Practice Address - Fax:281-207-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty