Provider Demographics
NPI:1275120636
Name:LAU, LISA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 NORTH LOOP W STE 670
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8119
Mailing Address - Country:US
Mailing Address - Phone:832-819-2917
Mailing Address - Fax:281-868-7036
Practice Address - Street 1:1900 NORTH LOOP W STE 670
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8119
Practice Address - Country:US
Practice Address - Phone:812-673-4360
Practice Address - Fax:281-868-7036
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA13645363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical