Provider Demographics
NPI:1003889635
Name:NAVARRO ROMAN, LYDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:NAVARRO ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYDIA
Other - Middle Name:NAVARRO
Other - Last Name:DE ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5815 GULF FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-5362
Mailing Address - Country:US
Mailing Address - Phone:713-643-0012
Mailing Address - Fax:713-643-5808
Practice Address - Street 1:5815 GULF FWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-5362
Practice Address - Country:US
Practice Address - Phone:713-643-0012
Practice Address - Fax:713-643-5808
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5826208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080500401Medicaid
TX080500401Medicaid
TX85001FMedicare ID - Type UnspecifiedMEDICARE ID