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General NPI Number Information
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NPI Number | 1902049091
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Entity Type | Organization
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Legal Business Name | YOUTHFUL ESSENCE MEDICAL SKIN AND LASER PC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 414 WEST GRAND PARKWAY 115
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-693-7546
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Fax | 281-693-7548
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Provider Business Mailing Address
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Address Line | 414 WEST GRAND PARKWAY 115
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City | KATY
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State | TX
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Zip | 77494
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Country | US
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Telephone | 281-693-7546
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Fax | 281-693-7548
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MICHAEL S GOMEZ
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Credential |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J4824
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | J4824
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | J4824
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License Number State | TX
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