Healthcare Provider Details

I. General information

NPI: 1871467308
Provider Name (Legal Business Name): ELIZABETH CAROLYN LUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

2911 BURNT OAK ST
SAN ANTONIO TX
78232-1803
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number245658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: