Provider Demographics
NPI:1144313560
Name:TASTARD, LUZ VIVIANA (MD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:VIVIANA
Last Name:TASTARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1878
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-5189
Mailing Address - Fax:713-790-6604
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1878
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-5189
Practice Address - Fax:713-790-6604
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL99262081P0004X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167632202Medicaid
TX167632206Medicaid
TX8GD938OtherBCBS
TX8EJ698OtherBLUE CROSS BLUE SHIELD
TX167632207Medicaid
TX542146ZSWDMedicare PIN
TX167632207Medicaid
TXB102213Medicare PIN
TX8GD938OtherBCBS
TX328950YMVQMedicare PIN