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General NPI Number Information
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NPI Number | 1629721345
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Entity Type | Organization
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Legal Business Name | PRISTINE SERENITY MED SPA LLC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 19121 W LAKE HOUSTON PKWY # 1
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City | HUMBLE
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State | TX
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Zip | 77346-4825
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Country | US
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Telephone | 832-819-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 14802 BARTON GROVE LN
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City | HUMBLE
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State | TX
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Zip | 77396-4234
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Country | US
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Telephone | 713-870-9738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BIANCA ROBINSON
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Credential |
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Telephone | 713-870-9738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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