# LIZA DE OLAZO BANAAG, M. D., P. A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558497040
- **Authorized official:** DR. LIZA DE OLAZO BANAAG MD (OWNER)
- **Authorized official phone:** (832) 646-5492

## Contact information

- **Practice address:** 965 J K AVENT DR, SUITE 100-A, GRENADA, MS 38901-5045
- **Practice address phone:** (662) 227-7446
- **Mailing address:** PO BOX 2329, GRENADA, MS 38902-2329
- **Mailing address phone:** (832) 646-5492

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0011X | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician | 19748 | MS | Yes |

## Other

- **Enumeration date:** 02/26/2007
- **Last updated:** 01/25/2008