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General NPI Number Information
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NPI Number | 1356165237
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Entity Type | Organization
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Legal Business Name | GRACEFUL REFLECTION, LLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 08/30/2025
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Provider Practice Location Address
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Address Line | 12855 EDGEWOOD PARK DR
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City | HOUSTON
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State | TX
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Zip | 77038-4023
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Country | US
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Telephone | 832-808-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 12855 EDGEWOOD PARK DR
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City | HOUSTON
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State | TX
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Zip | 77038-4023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | ASHLEY A LOPEZ
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Credential | AGCNS
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Telephone | 832-808-5734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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