Provider Demographics
NPI:1528018611
Name:COSTA-LUNA, CESAR A (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:COSTA-LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 W SAM HOUSTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5217
Mailing Address - Country:US
Mailing Address - Phone:956-783-1000
Mailing Address - Fax:956-783-9679
Practice Address - Street 1:1206 S F ST
Practice Address - Street 2:SUITE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6783
Practice Address - Country:US
Practice Address - Phone:956-444-0844
Practice Address - Fax:956-444-0845
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7679208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC77273Medicare UPIN