Basic Information
| Provider Information | |||||||||
| NPI: | 1760633176 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STA ANA | ||||||||
| FirstName: | LUCRECIA | ||||||||
| MiddleName: | TRABANINO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TRABANINO | ||||||||
| OtherFirstName: | LUCRECIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13811 MURPHY RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774774903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137721200 | ||||||||
| FaxNumber: | 7132556315 | ||||||||
| Practice Location | |||||||||
| Address1: | 23920 KATY FWY STE 410 | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774941341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137721200 | ||||||||
| FaxNumber: | 2816933522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2008 | ||||||||
| LastUpdateDate: | 06/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Q6291 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | ME101237 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | ME101237 | FL | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | Q6291 | TX | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1760633176 | 01 | NPI | OTHER | 146KE | 01 | FL | BCBS OF FL | OTHER | 351857301 | 05 | TX | MEDICAID | P00850343 | 01 | FL | RR MEDICARE | OTHER | 001458700 | 05 | FL | MEDICAID |