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Organization
FUSTOK COSMETIC AND RECONSTRUCTIVE SURGERY PA
Active
Organization
FUSTOK COSMETIC AND RECONSTRUCTIVE SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNI DIAZ (MEDICAL BILLING MANAGER)
(713) 621-2950
Entity
Organization
Contact information
Practice address
333 WEST LOOP N STE 410, HOUSTON, TX 77024-7709
(713) 621-2950
(713) 589-2011
Mailing address
333 WEST LOOP N STE 410, HOUSTON, TX 77024-7709
(713) 621-2950
(713) 589-2011
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
F4727
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F4727
STATE LICENSE
TX
Enumeration date
08/27/2018
Last updated
12/06/2024
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