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General NPI Number Information
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NPI Number | 1750568010
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Entity Type | Organization
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Legal Business Name | YOUTHFUL ESSENCE MEDICAL SKIN AND
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 414 W GRAND PKWY S STE 115
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City | KATY
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State | TX
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Zip | 77494-8351
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Country | US
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Telephone | 281-693-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 414 W GRAND PKWY S STE 115
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City | KATY
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State | TX
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Zip | 77494-8351
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Country | US
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Telephone | 281-693-7546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL S GOMEZ
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Credential | M.D. P.A.
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Telephone | 281-693-7546
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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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