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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