Healthcare Provider Details

I. General information

NPI: 1114993953
Provider Name (Legal Business Name): SERGIO H LUNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 AVENUE D
AUSTIN TX
78751
US

IV. Provider business mailing address

P.O.BOX 4934
AUSTIN TX
78751-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-524-1438
  • Fax:
Mailing address:
  • Phone: 512-524-1438
  • Fax: 512-440-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberJ7058
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2O8888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: