Provider Demographics
NPI:1811738735
Name:LACREMETA LLC DBA GJ SKIN CLINIC
Entity type:Organization
Organization Name:LACREMETA LLC DBA GJ SKIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:830-251-8232
Mailing Address - Street 1:13549 US HIGHWAY 87 W UNIT B
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5879
Mailing Address - Country:US
Mailing Address - Phone:830-251-8232
Mailing Address - Fax:
Practice Address - Street 1:13549 US HIGHWAY 87 W UNIT B
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5879
Practice Address - Country:US
Practice Address - Phone:830-251-8232
Practice Address - Fax:908-282-3628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LACREMETA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty