Provider Demographics
NPI:1609233642
Name:COMPLETE CARE DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:COMPLETE CARE DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:IJEOMA
Authorized Official - Last Name:FALEYE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:281-685-1005
Mailing Address - Street 1:1831 LATEXO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-1743
Mailing Address - Country:US
Mailing Address - Phone:281-685-1005
Mailing Address - Fax:
Practice Address - Street 1:1831 LATEXO DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1743
Practice Address - Country:US
Practice Address - Phone:281-685-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04617261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty