=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548463292
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCIANO J SARABOSING JR., MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2108 N LAURENT ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-578-3604
-----------------------------------------------------
Fax | 361-576-4397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2108 N LAURENT ST
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77901-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-578-3604
-----------------------------------------------------
Fax | 361-576-4397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRICIAN
-----------------------------------------------------
Name | DR. LUCIANO JO SARABOSING JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 361-578-3604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | J7177
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------