MEDICARE: ALISA LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1245172410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA LU

Provider Business Mailing Address
First Line	:	1 BAYLOR PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3498
Country	:	US
Telephone Number	:	832-824-1170
Fax Number	:	832-825-3411

Provider Business Practice Location Address
First Line	:	1 BAYLOR PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3498
Country	:	US
Telephone Number	:	832-824-1170
Fax Number	:	832-825-3411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ ALISA LU ” Practice Location

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