Provider Demographics
NPI:1467931147
Name:BATISTA LAGO, ROGER (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:BATISTA LAGO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W GULF BANK RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-2365
Mailing Address - Country:US
Mailing Address - Phone:832-917-8549
Mailing Address - Fax:
Practice Address - Street 1:7575 BELLAIRE BLVD APT 10E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5007
Practice Address - Country:US
Practice Address - Phone:832-917-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty