Provider Demographics
NPI:1982111399
Name:JOINT REJUVENATION CENTER, PLLC
Entity Type:Organization
Organization Name:JOINT REJUVENATION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-212-7547
Mailing Address - Street 1:2724 YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2120
Mailing Address - Country:US
Mailing Address - Phone:713-706-6143
Mailing Address - Fax:832-409-3169
Practice Address - Street 1:2724 YALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2120
Practice Address - Country:US
Practice Address - Phone:713-706-6143
Practice Address - Fax:832-409-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ45532086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty