Healthcare Provider Details

I. General information

NPI: 1427064062
Provider Name (Legal Business Name): LUZ STARCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 VANCE JACKSON BUILDING 2 SUITE 201
SAN ANTONIO TX
78230
US

IV. Provider business mailing address

12050 VANCE JACKSON BUILDING 2 SUITE 201
SAN ANTONIO TX
78230
US

V. Phone/Fax

Practice location:
  • Phone: 210-699-8881
  • Fax: 210-699-0503
Mailing address:
  • Phone: 210-699-8881
  • Fax: 210-699-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberJ7382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: