Provider Demographics
NPI:1801089792
Name:ALCAZAR-PESANTE, LISA GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GRACE
Last Name:ALCAZAR-PESANTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6451 N FEDERAL HWY
Mailing Address - Street 2:WEATHERBY LOCUMS, STE 800
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-343-3059
Mailing Address - Fax:800-463-3579
Practice Address - Street 1:23920 KATY FWY STE 310
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0881
Practice Address - Country:US
Practice Address - Phone:281-392-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH5415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E74606Medicare UPIN