MEDICARE: TRU LUXE MEDSPA AND WELLNESS

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1780340844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRU LUXE MEDSPA AND WELLNESS

Provider Business Mailing Address
First Line	:	20502 SPRING ASPEN LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-5539
Country	:	US
Telephone Number	:	346-296-0520
Fax Number	:

Provider Business Practice Location Address
First Line	:	5529 LOUETTA RD STE A7
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7883
Country	:	US
Telephone Number	:	346-296-0520
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	PAULETTE SENEGAL
Credential	:	APRN, FNP-C
Telephone Number	:	346-296-0520

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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