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Organization
LIZA DE OLAZO BANAAG, M. D., P. A.
Active
Organization
LIZA DE OLAZO BANAAG, M. D., P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LIZA DE OLAZO BANAAG MD (OWNER)
(832) 646-5492
Entity
Organization
Contact information
Practice address
965 J K AVENT DR, SUITE 100-A, GRENADA, MS 38901-5045
(662) 227-7446
Mailing address
PO BOX 2329, GRENADA, MS 38902-2329
(832) 646-5492
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
19748
MS
Other
Enumeration date
02/26/2007
Last updated
01/25/2008
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