Provider Demographics
NPI:1285042556
Name:SOUTH TEXAS AESTHETIC AND RECONSTRUCTIVE SURGERY PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS AESTHETIC AND RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:STARS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-201-2806
Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-201-2806
Mailing Address - Fax:888-878-2254
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-201-2806
Practice Address - Fax:888-878-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty