Provider Demographics
NPI:1124353511
Name:DERMAGENIX LLC
Entity type:Organization
Organization Name:DERMAGENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-662-3385
Mailing Address - Street 1:6030 S RIVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2913
Mailing Address - Country:US
Mailing Address - Phone:713-662-3376
Mailing Address - Fax:713-662-3385
Practice Address - Street 1:6030 S RICE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2913
Practice Address - Country:US
Practice Address - Phone:713-662-3376
Practice Address - Fax:713-662-3385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOA K VO, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO0646123OtherMEDICARE RAILROAD
TX155196201Medicaid
TX155196201Medicaid