Provider Demographics
NPI:1104800853
Name:RONDON, LUISA A (MD)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:A
Last Name:RONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N WESTMORELAND RD
Practice Address - Street 2:DEHARO SALDIVAR HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1656
Practice Address - Country:US
Practice Address - Phone:214-266-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139128604Medicaid
TX139128614Medicaid
TX139128618Medicaid
TX139128624Medicaid
TX139128601Medicaid
TX139128602Medicaid
TX139128613Medicaid
TX139128619Medicaid
TX139128610Medicaid
TX139128608Medicaid
TX139128609Medicaid
TX148765401Medicaid
TX139128603Medicaid
TX139128615Medicaid
TX139128606Medicaid
TX139128607Medicaid
TX139128612Medicaid
TX139128623Medicaid
TX139128613Medicaid
TX148765401Medicaid