Provider Demographics
NPI:1154082147
Name:HOUSTONMD MEDSPA & WELLNESS LLC
Entity Type:Organization
Organization Name:HOUSTONMD MEDSPA & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:C
Authorized Official - Last Name:UZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-234-2795
Mailing Address - Street 1:12000 RICHMOND AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2428
Mailing Address - Country:US
Mailing Address - Phone:832-234-2795
Mailing Address - Fax:832-568-3536
Practice Address - Street 1:12000 RICHMOND AVE STE 215
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2428
Practice Address - Country:US
Practice Address - Phone:832-234-2795
Practice Address - Fax:832-568-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty