Provider Demographics
NPI:1952585481
Name:YOUTHFUL ESSENCE MEDICAL
Entity Type:Organization
Organization Name:YOUTHFUL ESSENCE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SAENZ
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-693-7546
Mailing Address - Street 1:809 ESCANDON AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9722
Mailing Address - Country:US
Mailing Address - Phone:956-592-1894
Mailing Address - Fax:
Practice Address - Street 1:414 W GRAND PKWY S STE 115
Practice Address - Street 2:
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:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center