Provider Demographics
NPI:1942209986
Name:SANTOS, LISA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:DIANE
Other - Last Name:SANTOS-PUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-529-9020
Mailing Address - Fax:713-529-4778
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 1030
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-529-9020
Practice Address - Fax:713-529-4778
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8398208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F3612Medicare ID - Type Unspecified
TXC78383Medicare UPIN