Provider Demographics
NPI:1043409881
Name:ANTIAGING CENTERS OF TEXAS MDPA
Entity Type:Organization
Organization Name:ANTIAGING CENTERS OF TEXAS MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-433-4352
Mailing Address - Street 1:5318 WESLAYAN ST # 183
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1048
Mailing Address - Country:US
Mailing Address - Phone:713-589-9115
Mailing Address - Fax:281-201-4560
Practice Address - Street 1:2646 S LOOP W STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2678
Practice Address - Country:US
Practice Address - Phone:713-589-9115
Practice Address - Fax:281-201-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty