MEDICARE: ABOUT FACE MED SPA & WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	N1731	TX

General Provider Information

NPI Number	:	1588933105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOUT FACE MED SPA & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	201 E CENTRAL TEXAS EXPY
Second Line	:	SUITE 1260
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1887
Country	:	US
Telephone Number	:	254-781-8169
Fax Number	:	254-781-8244

Provider Business Practice Location Address
First Line	:	201 E CENTRAL TEXAS EXPY
Second Line	:	SUITE 1260
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1887
Country	:	US
Telephone Number	:	254-781-8169
Fax Number	:	254-781-8244

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/STAFF PHYSICIAN
Name	:	DR. ROBERT LEJAWA
Credential	:	D.O
Telephone Number	:	254-781-8169

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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