Provider Demographics
NPI:1619024825
Name:LOREDO, ALEJANDRO (LSA)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:LOREDO
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 W HARDY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-3523
Mailing Address - Country:US
Mailing Address - Phone:713-259-2998
Mailing Address - Fax:346-444-5400
Practice Address - Street 1:12411 W HARDY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-3523
Practice Address - Country:US
Practice Address - Phone:713-259-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty