MEDICARE: LUISA M ALZATE

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	163WG0100X	Gastroenterology Registered Nurse	859750	TX

General Provider Information

NPI Number	:	1174086003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA M ALZATE

Provider Business Mailing Address
First Line	:	708 LITTLE JOHN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-3608
Country	:	US
Telephone Number	:	832-741-8607
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 BERTNER AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3901
Country	:	US
Telephone Number	:	832-741-8607
Fax Number	:

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

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	04/08/2019

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