Provider Demographics
NPI:1316078819
Name:AESTHETIC ENHANCEMENT COSMETIC & LASER CTR
Entity type:Organization
Organization Name:AESTHETIC ENHANCEMENT COSMETIC & LASER CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-496-2639
Mailing Address - Street 1:525 OAK CENTRE DR
Mailing Address - Street 2:#260
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3944
Mailing Address - Country:US
Mailing Address - Phone:210-496-2639
Mailing Address - Fax:
Practice Address - Street 1:525 OAK CENTRE DR
Practice Address - Street 2:#250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3944
Practice Address - Country:US
Practice Address - Phone:210-496-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7540261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical