Provider Demographics
NPI:1659556975
Name:FOSTER, LIZA AVA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:AVA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 DESERT BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3824
Mailing Address - Country:US
Mailing Address - Phone:281-250-7207
Mailing Address - Fax:281-232-2169
Practice Address - Street 1:7010 DESERT BLUFF LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3824
Practice Address - Country:US
Practice Address - Phone:281-250-7207
Practice Address - Fax:281-232-2169
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator