Provider Demographics
NPI:1760547624
Name:LASSUS, GABY ANABEL (DPM)
Entity Type:Individual
Prefix:
First Name:GABY
Middle Name:ANABEL
Last Name:LASSUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 AUGUSTA DR STE 270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5033
Mailing Address - Country:US
Mailing Address - Phone:713-784-3668
Mailing Address - Fax:713-784-3648
Practice Address - Street 1:2400 AUGUSTA DR.
Practice Address - Street 2:SUITE 270
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-784-3668
Practice Address - Fax:713-784-3648
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092792301Medicaid
TX092792301Medicaid
TXU16576Medicare UPIN