Basic Information
| Provider Information | |||||||||
| NPI: | 1760544340 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUONG | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 CLARK RD STE L2 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864241584 | ||||||||
| FaxNumber: | 8889007145 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 CLARK RD STE L2 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864241584 | ||||||||
| FaxNumber: | 8889007145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME98112 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | ME98112 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.