Provider Demographics
NPI:1104288778
Name:OLAZAGASTI LOURIDO, JEANNETTE MARIE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:MARIE
Last Name:OLAZAGASTI LOURIDO
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:601 WESTPARK WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3972
Mailing Address - Country:US
Mailing Address - Phone:817-754-8884
Mailing Address - Fax:817-977-9077
Practice Address - Street 1:601 WESTPARK WAY STE 100
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3972
Practice Address - Country:US
Practice Address - Phone:817-754-8884
Practice Address - Fax:817-977-9077
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT0879207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology