Provider Demographics
NPI:1477584845
Name:DEVENIR AESTHETICS, PA
Entity Type:Organization
Organization Name:DEVENIR AESTHETICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-477-3778
Mailing Address - Street 1:3807 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:#201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8965
Mailing Address - Country:US
Mailing Address - Phone:512-477-3778
Mailing Address - Fax:512-477-3626
Practice Address - Street 1:3807 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8965
Practice Address - Country:US
Practice Address - Phone:512-477-3778
Practice Address - Fax:512-477-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1003610OtherCLIA
0040HWOtherBCBS GROUP
45D1003610OtherCLIA