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General NPI Number Information
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NPI Number | 1669633145
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Entity Type | Organization
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Legal Business Name | AESTHETIC & ACUPUNCTURE CLINIC OF TEXAS PLLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 354 STONE HILL DRIVE
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City | BRENHAM
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State | TX
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Zip | 77833
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Country | US
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Telephone | 979-421-6300
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Fax | 979-421-6618
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Provider Business Mailing Address
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Address Line | 354 STONE HILL DRIVE
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City | BRENHAM
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State | TX
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Zip | 77833
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Country | US
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Telephone | 979-421-6300
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Fax | 979-421-6618
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Authorized Official
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Title or Position | MD MEDICAL DIRECTOR
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Name | ALFONSO ENRIQUE ALDAMA
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Credential | MD
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Telephone | 979-421-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | E7545
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License Number State | TX
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