Provider Demographics
NPI:1134507916
Name:AESTHETIC MEDICAL CENTER
Entity Type:Organization
Organization Name:AESTHETIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:281-646-1935
Mailing Address - Street 1:2505 DUNLAVY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2405
Mailing Address - Country:US
Mailing Address - Phone:281-809-0207
Mailing Address - Fax:281-809-6598
Practice Address - Street 1:2505 DUNLAVY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2405
Practice Address - Country:US
Practice Address - Phone:281-809-0207
Practice Address - Fax:281-809-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty