Provider Demographics
NPI:1215386057
Name:CLEAR LAKE FACIAL AESTHETIC & RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:CLEAR LAKE FACIAL AESTHETIC & RECONSTRUCTIVE SURGERY
Other - Org Name:CLFARS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-360-4515
Mailing Address - Street 1:18100 SAINT JOHN DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3631
Mailing Address - Country:US
Mailing Address - Phone:832-720-5477
Mailing Address - Fax:281-335-7766
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:832-720-5477
Practice Address - Fax:281-335-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP7468207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty