Provider Demographics
NPI:1639341233
Name:FAMILY DERMATOLOGY&SKIN CARE CENTER, PA
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY&SKIN CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABELLA
Authorized Official - Middle Name:KWAATEMA
Authorized Official - Last Name:GYENING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-902-1026
Mailing Address - Street 1:10905 MEMORIAL HERMANN DR STE 113
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3490
Mailing Address - Country:US
Mailing Address - Phone:281-902-1026
Mailing Address - Fax:713-340-1725
Practice Address - Street 1:10905 MEMORIAL HERMANN DR STE 113
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3490
Practice Address - Country:US
Practice Address - Phone:281-902-1026
Practice Address - Fax:713-340-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6984261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0305Medicare PIN