| NPI | 1780343848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDRA VARNER ELLIS Provider / Owner 210-575-2876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| 208600000X Surgery | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-02-15 |