Provider Demographics
NPI:1942606793
Name:ELEGANCE BODY ENHANCEMENT CENTERS
Entity Type:Organization
Organization Name:ELEGANCE BODY ENHANCEMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOREDO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:972-939-4974
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-0243
Mailing Address - Country:US
Mailing Address - Phone:972-939-4974
Mailing Address - Fax:972-939-4973
Practice Address - Street 1:2008 E HEBRON PKWY
Practice Address - Street 2:STE 120
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1602
Practice Address - Country:US
Practice Address - Phone:972-939-4974
Practice Address - Fax:972-939-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN02282086S0105X
2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty