Healthcare Provider Details

I. General information

NPI: 1386801041
Provider Name (Legal Business Name): AFFINITY AESTHETICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25410 I-45 NORTH
SPRING TX
77386-1351
US

IV. Provider business mailing address

25410 I-45 NORTH
SPRING TX
77386-1351
US

V. Phone/Fax

Practice location:
  • Phone: 281-367-1414
  • Fax: 281-363-5686
Mailing address:
  • Phone: 281-367-1414
  • Fax: 281-363-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License NumberJ4553
License Number StateTX

VIII. Authorized Official

Name: DR. JUSTINA PEPPLE TAUBE
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 832-385-2780