Provider Demographics
NPI:1558672931
Name:SANTANA-BLAISE, LIZBETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:LIZBETH
Middle Name:
Last Name:SANTANA-BLAISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 CRENSHAW
Mailing Address - Street 2:#200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3139
Mailing Address - Country:US
Mailing Address - Phone:281-998-2488
Mailing Address - Fax:281-998-7711
Practice Address - Street 1:5050 CRENSHAW
Practice Address - Street 2:#200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3139
Practice Address - Country:US
Practice Address - Phone:281-998-2488
Practice Address - Fax:281-998-7711
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654463363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105237Medicare UPIN