Individual
LISA EDMISTON DE YBARRONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5656 KELLEY STREET, 500, HOUSTON, TX 77026-1967
(713) 566-4541
(713) 566-5844
Mailing address
5656 KELLEY STREET, HOUSTON, TX 77026-1967
(713) 566-4541
(713) 566-5844
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J3696
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125859205
—
TX
05
—
125859206
—
TX
05
—
125859208
—
TX
01
—
8G9223
BCBS
TX
05
—
TPI#125859206
—
TX
Enumeration date
07/09/2006
Last updated
11/06/2020
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