MEDICARE: PRESTIGE MEDICAL CENTER AND WELLNESS SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	261QM1300X	Multi-Specialty Clinic/Center
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1386467595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE MEDICAL CENTER AND WELLNESS SPA

Provider Business Mailing Address
First Line	:	2370 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3700
Country	:	US
Telephone Number	:	281-810-9292
Fax Number	:	281-810-9392

Provider Business Practice Location Address
First Line	:	2370 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3700
Country	:	US
Telephone Number	:	281-810-9292
Fax Number	:	281-810-9392

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ARIEL HERNANDEZ
Credential	:
Telephone Number	:	281-810-9292

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	12/03/2024

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