Provider Demographics
NPI:1114993953
Name:LUNA, SERGIO H (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:H
Last Name:LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 4934
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2911
Mailing Address - Country:US
Mailing Address - Phone:512-524-1438
Mailing Address - Fax:512-440-4059
Practice Address - Street 1:4408 AVENUE D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-524-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ70582084P0800X
NY2O88882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT253553OtherVALUE OPTIONS
VT59984OtherBCBS
VTP00249549OtherRAILROAD MEDICARE
VT714676OtherMVP
VT1010494Medicaid
VTCIGNAOther2189611
VT356474OtherMHN
VT714676OtherMVP
VT356474OtherMHN