Individual
DR. LUZ VIVIANA TASTARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
6560 FANNIN ST, SUITE 1878, HOUSTON, TX 77030-2761
(713) 441-5189
(713) 790-6604
Mailing address
6560 FANNIN ST, SUITE 1878, HOUSTON, TX 77030-2761
(713) 441-5189
(713) 790-6604
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
L9926
TX
2081P0004X
Spinal Cord Injury Medicine Physician
L9926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167632202
—
TX
05
—
167632206
—
TX
05
—
167632207
—
TX
01
—
8EJ698
BLUE CROSS BLUE SHIELD
TX
01
—
8GD938
BCBS
TX
Enumeration date
09/30/2006
Last updated
11/20/2017
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