MEDICARE: AFFINITY AESTHETICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	J4553	TX

General Provider Information

NPI Number	:	1386801041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY AESTHETICS PLLC

Provider Business Mailing Address
First Line	:	25410 I-45 NORTH
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1351
Country	:	US
Telephone Number	:	281-367-1414
Fax Number	:	281-363-5686

Provider Business Practice Location Address
First Line	:	25410 I-45 NORTH
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-1351
Country	:	US
Telephone Number	:	281-367-1414
Fax Number	:	281-363-5686

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JUSTINA PEPPLE TAUBE
Credential	:	M.D
Telephone Number	:	832-385-2780

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	08/25/2015

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