Provider Demographics
NPI:1760439335
Name:SARABOSING, LUCIANO JO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:JO
Last Name:SARABOSING
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:806 CHARLESTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3822
Mailing Address - Country:US
Mailing Address - Phone:361-574-8553
Mailing Address - Fax:361-574-8583
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135718809Medicaid
TX0038MNOtherBLUECROSSS BLUESHIELD
TXN0089582OtherTEXAS CONTROLLED SUBSTANC
TX16758440OtherDRIVER'S LICENSE
TX170867901Medicaid
TX170867902Medicaid
TXJ7177OtherSTATE MEDICAL LICENSE
TX45D1037942OtherCLIA
TX45D1037942OtherCLIA
TX900146409OtherTIN
TX170867901Medicaid