Provider Demographics
NPI:1164160404
Name:RIVER OAKS AESTHETIC & WELLNESS SPA, INC.
Entity Type:Organization
Organization Name:RIVER OAKS AESTHETIC & WELLNESS SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:USORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-466-9714
Mailing Address - Street 1:PO BOX 2269
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2269
Mailing Address - Country:US
Mailing Address - Phone:713-408-0672
Mailing Address - Fax:
Practice Address - Street 1:2111 WEST LOOP SOUTH
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-408-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy