Organization · NPI-2

247 Obgyn Surgical Assisting Services

Physician Assistant, Surgical · Grand Prairie, TX

NPI number1790179893

StatusActive

Last updated in NPPESMar 26, 2015

Details

NPI: 1790179893
Entity type: Organization (NPI-2)
Legal business name: 247 Obgyn Surgical Assisting Services
Organization subpart: No
Enumeration date: Mar 26, 2015
Last updated: Mar 26, 2015

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363AS0400X	Physician Assistant, Surgical	–	–	Yes
246ZC0007X	Specialist/Technologist, Other, Surgical Assistant	–	–

Other names

Ricardo Chujutalli Csa (Doing Business As)

Practice location

4924 Marsh Harrier Ave
Grand Prairie, TX 75052-3057

Phone 972-652-0705 · Fax 972-752-7889

Mailing address

4924 Marsh Harrier Ave
Grand Prairie, TX 75052-3057

Phone 972-652-0705 · Fax 972-752-7889

Authorized official

Ricardo Chujutalli
Manager/Owner
9726520705

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