Provider Demographics
NPI:1760633176
Name:STA ANA, LUCRECIA TRABANINO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCRECIA
Middle Name:TRABANINO
Last Name:STA ANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCRECIA
Other - Middle Name:
Other - Last Name:TRABANINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13811 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4903
Mailing Address - Country:US
Mailing Address - Phone:713-772-1200
Mailing Address - Fax:713-255-6315
Practice Address - Street 1:23920 KATY FWY STE 410
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1341
Practice Address - Country:US
Practice Address - Phone:713-772-1200
Practice Address - Fax:281-693-3522
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6291208600000X, 208C00000X
FLME101237208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146KEOtherBCBS OF FL
FL001458700Medicaid
FLP00850343OtherRR MEDICARE
1760633176OtherNPI
TX351857301Medicaid
TX459446ZK3JMedicare PIN
FL001458700Medicaid