MEDICARE: EDUARDO ANDREAZZA DAL LAGO

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	2085R0202X	Diagnostic Radiology Physician	48961	TX

General Provider Information

NPI Number	:	1609667245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO ANDREAZZA DAL LAGO

Provider Business Mailing Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	713-500-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1501
Country	:	US
Telephone Number	:	832-312-1012
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	02/24/2026

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Directions to “ EDUARDO ANDREAZZA DAL LAGO ” Practice Location

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