Provider Demographics
NPI:1134531080
Name:LAZCANO, OTILIA (MD, LSA)
Entity type:Individual
Prefix:
First Name:OTILIA
Middle Name:
Last Name:LAZCANO
Suffix:
Gender:F
Credentials:MD, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21175 STATE HIGHWAY 249 STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1655
Mailing Address - Country:US
Mailing Address - Phone:713-269-7466
Mailing Address - Fax:
Practice Address - Street 1:11922 COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2748
Practice Address - Country:US
Practice Address - Phone:713-269-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12-230208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00837OtherLSA