MEDICARE: MISS LISA LAU PA-C

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	363AS0400X	Surgical Physician Assistant	PA13645	TX

General Provider Information

NPI Number	:	1275120636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA LAU PA-C

Provider Business Mailing Address
First Line	:	1900 NORTH LOOP W STE 670
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8119
Country	:	US
Telephone Number	:	832-819-2917
Fax Number	:	281-868-7036

Provider Business Practice Location Address
First Line	:	1900 NORTH LOOP W STE 670
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8119
Country	:	US
Telephone Number	:	812-673-4360
Fax Number	:	281-868-7036

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	08/09/2023

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