Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD432001 | PA |
N | 2080P0202X | Pediatric Cardiologist | MD432001 | PA |
N | 2080P0202X | Pediatric Cardiologist | Q0097 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | Q0097 | TX |
NPI | 1174720437 |
---|---|
Provider Name | Dr. Javier Jorge Lasa |
First Address | Houston, TX 77030-2300 |
Second Address | Houston, TX 77030-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 02/06/2014 |