Provider Demographics
NPI:1710151642
Name:REJUVENUS AESTHETICS
Entity Type:Organization
Organization Name:REJUVENUS AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-350-5397
Mailing Address - Street 1:600 RIVER POINTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2868
Mailing Address - Country:US
Mailing Address - Phone:936-760-2696
Mailing Address - Fax:936-756-2662
Practice Address - Street 1:600 RIVER POINTE DR STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2868
Practice Address - Country:US
Practice Address - Phone:936-760-2696
Practice Address - Fax:936-756-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8612208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty