Provider Demographics
NPI:1265138226
Name:WELLNESS PASS BY LURAGUIZ MD
Entity type:Organization
Organization Name:WELLNESS PASS BY LURAGUIZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LURAGUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-426-8351
Mailing Address - Street 1:1534 ELIZABETH AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4531
Mailing Address - Country:US
Mailing Address - Phone:318-431-8613
Mailing Address - Fax:318-314-2203
Practice Address - Street 1:1534 ELIZABETH AVE STE 401
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4531
Practice Address - Country:US
Practice Address - Phone:318-431-8613
Practice Address - Fax:318-314-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D1055958OtherCLIA