Provider Demographics
NPI:1750568010
Name:YOUTHFUL ESSENCE MEDICAL SKIN AND
Entity type:Organization
Organization Name:YOUTHFUL ESSENCE MEDICAL SKIN AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-693-7546
Mailing Address - Street 1:414 W GRAND PKWY S
Mailing Address - Street 2:STE 115
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8351
Mailing Address - Country:US
Mailing Address - Phone:281-693-7546
Mailing Address - Fax:
Practice Address - Street 1:414 W GRAND PKWY S
Practice Address - Street 2:STE 115
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8351
Practice Address - Country:US
Practice Address - Phone:281-693-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A5096Medicare PIN