Provider Demographics
NPI:1114566023
Name:PERFECT LIFESTYLE
Entity Type:Organization
Organization Name:PERFECT LIFESTYLE
Other - Org Name:LIFESTYLE MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:AURORA
Authorized Official - Last Name:PUESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-785-1272
Mailing Address - Street 1:25722 KINGSLAND BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2643
Mailing Address - Country:US
Mailing Address - Phone:713-785-1272
Mailing Address - Fax:713-785-1295
Practice Address - Street 1:26077 NELSON WAY STE 1202
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6698
Practice Address - Country:US
Practice Address - Phone:713-785-1272
Practice Address - Fax:713-785-1295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE ACEVEDO, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-26
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty