Provider Demographics
NPI:1548463292
Name:LUCIANO J SARABOSING JR., MD, PA
Entity type:Organization
Organization Name:LUCIANO J SARABOSING JR., MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SARABOSING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-3604
Mailing Address - Street 1:2108 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5451
Mailing Address - Country:US
Mailing Address - Phone:361-578-3604
Mailing Address - Fax:361-576-4397
Practice Address - Street 1:2108 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5451
Practice Address - Country:US
Practice Address - Phone:361-578-3604
Practice Address - Fax:361-576-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherSSN
TX208000000XOtherTAXONOMY
TX170867902Medicaid
TXN0089582OtherDPS
TXJ7177OtherTEXAS MED LICENSE
TX0038MNOtherBLUECROSSBLUESHIELD
TX45D1037942OtherCLIA
TX135718809Medicaid
TX170867901Medicaid
TX170867901Medicaid