Healthcare Provider Details
I. General information
NPI: 1174086003
Provider Name (Legal Business Name): LUISA M ALZATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6901 BERTNER AVE
HOUSTON TX
77030-3901
US
IV. Provider business mailing address
708 LITTLE JOHN LN
HOUSTON TX
77024-3608
US
V. Phone/Fax
- Phone: 832-741-8607
- Fax:
- Phone: 832-741-8607
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WG0100X |
| Taxonomy | Gastroenterology Registered Nurse |
| License Number | 859750 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: