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General NPI Number Information
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NPI Number | 1134507916
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Entity Type | Organization
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Legal Business Name | AESTHETIC MEDICAL CENTER
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 2505 DUNLAVY ST
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City | HOUSTON
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State | TX
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Zip | 77006-2405
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Country | US
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Telephone | 281-809-0207
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Fax | 281-809-6598
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Provider Business Mailing Address
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Address Line | 2505 DUNLAVY ST
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City | HOUSTON
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State | TX
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Zip | 77006-2405
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Country | US
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Telephone | 281-809-0207
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Fax | 281-809-6598
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Authorized Official
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Title or Position | ADMIN
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Name | MRS. SANDRA A RODRIGUEZ
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Credential | ADMIN
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Telephone | 281-646-1935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K4195
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License Number State | TX
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