Provider Demographics
NPI:1588933105
Name:ABOUT FACE MED SPA & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ABOUT FACE MED SPA & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEJAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-781-8169
Mailing Address - Street 1:201 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 1260
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1887
Mailing Address - Country:US
Mailing Address - Phone:254-781-8169
Mailing Address - Fax:254-781-8244
Practice Address - Street 1:201 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 1260
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1887
Practice Address - Country:US
Practice Address - Phone:254-781-8169
Practice Address - Fax:254-781-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1731261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care