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General NPI Number Information
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NPI Number | 1033624663
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Entity Type | Organization
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Legal Business Name | TEXAS CENTER FOR FACIAL PLASTIC & LASER SURGERY, LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 14603 HUEBNER RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5469
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Country | US
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Telephone | 210-468-5426
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Fax | 210-468-3282
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Provider Business Mailing Address
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Address Line | 14603 HUEBNER RD STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5469
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Country | US
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Telephone | 210-468-5426
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Fax | 210-468-3282
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Authorized Official
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Title or Position | CREDENTIALING ACCOUNT MANAGER
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Name | MS. KELLIE HAWKINS
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Credential |
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Telephone | 210-298-6847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State | TX
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