MEDICARE: DR. LISA GRACE ALCAZAR-PESANTE M.D.

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	208000000X	Pediatrics Physician	H5415	TX

General Provider Information

NPI Number	:	1801089792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA GRACE ALCAZAR-PESANTE M.D.

Provider Business Mailing Address
First Line	:	6451 N FEDERAL HWY
Second Line	:	WEATHERBY LOCUMS, STE 800
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-343-3059
Fax Number	:	800-463-3579

Provider Business Practice Location Address
First Line	:	23920 KATY FWY STE 310
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0881
Country	:	US
Telephone Number	:	281-392-8920
Fax Number	:

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

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	11/21/2019

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