Provider Demographics
NPI:1760979231
Name:LURAGUIZ, MARIA VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:LURAGUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8426
Mailing Address - Country:US
Mailing Address - Phone:318-564-6225
Mailing Address - Fax:
Practice Address - Street 1:1534 ELIZABETH AVE STE 401A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4531
Practice Address - Country:US
Practice Address - Phone:318-431-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA327573207R00000X
TXT1446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program