MEDICARE: ROGER BATISTA LAGO FNP-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	363LF0000X	Family Nurse Practitioner	1141103	TX

General Provider Information

NPI Number	:	1467931147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER BATISTA LAGO FNP-C

Provider Business Mailing Address
First Line	:	302 W GULF BANK RD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-2365
Country	:	US
Telephone Number	:	832-917-8549
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 BELLAIRE BLVD APT 10E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-5007
Country	:	US
Telephone Number	:	832-917-8549
Fax Number	:

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

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	12/19/2023

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