Provider Demographics
NPI:1801813704
Name:LANUZA, MARISA RIVERA (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:RIVERA
Last Name:LANUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3957
Mailing Address - Country:US
Mailing Address - Phone:713-663-6322
Mailing Address - Fax:713-663-6944
Practice Address - Street 1:5420 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3957
Practice Address - Country:US
Practice Address - Phone:713-663-6322
Practice Address - Fax:713-663-6944
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5954208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG5954Medicaid