1528789054 NPI number — ALICIA'S BODY RESTORATION CLIMIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528789054 NPI number — ALICIA'S BODY RESTORATION CLIMIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALICIA'S BODY RESTORATION CLIMIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528789054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 KATY GAP RD APT 34105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-7733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-757-6001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23410 GRAND RESERVE DR STE 604
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-220-6130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
MYLES
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
SHERRAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-757-6001

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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