Healthcare Provider Details

I. General information

NPI: 1518270164
Provider Name (Legal Business Name): ANA LUIZA LOVIAT SOUZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
JACKSON MS
39216-4505
US

IV. Provider business mailing address

2500 NORTH STATE STREET UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5200
  • Fax: 601-984-2086
Mailing address:
  • Phone: 601-984-5200
  • Fax: 601-984-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number788-L
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: