Provider Demographics
NPI:1003448176
Name:AMACAN, LAMBERTO L
Entity Type:Individual
Prefix:
First Name:LAMBERTO
Middle Name:L
Last Name:AMACAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9319 COMANCHE PEAK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5855
Mailing Address - Country:US
Mailing Address - Phone:832-876-4579
Mailing Address - Fax:
Practice Address - Street 1:9319 COMANCHE PEAK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5855
Practice Address - Country:US
Practice Address - Phone:832-876-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41183722172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver