Provider Demographics
NPI:1386801041
Name:AFFINITY AESTHETICS PLLC
Entity type:Organization
Organization Name:AFFINITY AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:PEPPLE
Authorized Official - Last Name:TAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-385-2780
Mailing Address - Street 1:25410 I-45 NORTH
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1351
Mailing Address - Country:US
Mailing Address - Phone:281-367-1414
Mailing Address - Fax:281-363-5686
Practice Address - Street 1:25410 I-45 NORTH
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1351
Practice Address - Country:US
Practice Address - Phone:281-367-1414
Practice Address - Fax:281-363-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4553261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG08197Medicare UPIN