Provider Demographics
NPI:1013470939
Name:CARMONA, LUIS GABRIEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GABRIEL
Last Name:CARMONA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-8312
Mailing Address - Country:US
Mailing Address - Phone:832-418-3915
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77012-3711
Practice Address - Country:US
Practice Address - Phone:832-538-0974
Practice Address - Fax:832-767-2163
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX849764163WE0003X
TXAP142424207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency