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General NPI Number Information
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NPI Number | 1710151642
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Entity Type | Organization
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Legal Business Name | REJUVENUS AESTHETICS
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 600 RIVER POINTE DR STE 200
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City | CONROE
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State | TX
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Zip | 77304-2868
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Country | US
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Telephone | 936-760-2696
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Fax | 936-756-2662
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Provider Business Mailing Address
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Address Line | 600 RIVER POINTE DR STE 200
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City | CONROE
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State | TX
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Zip | 77304-2868
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Country | US
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Telephone | 936-760-2696
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Fax | 936-756-2662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILBERTO CORTES
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Credential | M.D.
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Telephone | 414-350-5397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M8612
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License Number State | TX
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