MEDICARE: DR. LISA NASSIF WRIGHT MD

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	208000000X	Pediatrics Physician	M8643	TX
2	2084N0400X	Neurology Physician	M8643	TX
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	M8643	TX

General Provider Information

NPI Number	:	1780858167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA NASSIF WRIGHT MD

Provider Business Mailing Address
First Line	:	3618 EMERALD FALLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3738
Country	:	US
Telephone Number	:	713-589-7020
Fax Number	:	713-554-2031

Provider Business Practice Location Address
First Line	:	3301 PLAINVIEW ST STE 8
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:	713-589-7020
Fax Number	:	713-554-2031

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

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	05/06/2022

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