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General NPI Number Information
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NPI Number | 1215386057
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE FACIAL AESTHETIC & RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 06/11/2016
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Last Update Date | 06/11/2016
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Provider Practice Location Address
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Address Line | 18100 SAINT JOHN DR SUITE 240
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City | HOUSTON
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State | TX
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Zip | 77058-3631
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Country | US
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Telephone | 832-720-5477
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Fax | 281-335-7766
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Provider Business Mailing Address
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Address Line | 18100 SAINT JOHN DR SUITE 240
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City | HOUSTON
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State | TX
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Zip | 77058-3631
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Country | US
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Telephone | 832-720-5477
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Fax | 281-335-7766
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA HU
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Credential | M.D.
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Telephone | 832-360-4515
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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 | P7468
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License Number State | TX
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