Provider Demographics
NPI:1386331650
Name:LEBLANC MED SPA CLINIC PLLC
Entity type:Organization
Organization Name:LEBLANC MED SPA CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:281-246-0061
Mailing Address - Street 1:17832 MOUND RD STE F
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4820
Mailing Address - Country:US
Mailing Address - Phone:281-246-0061
Mailing Address - Fax:281-246-0063
Practice Address - Street 1:17832 MOUND RD STE F
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4820
Practice Address - Country:US
Practice Address - Phone:281-246-0061
Practice Address - Fax:281-246-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty