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NPI Code Detail

MEDICARE: DR. JUAN MANUAL BOSSANO MD

MEDICARE: DR. JUAN MANUAL BOSSANO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080N0001XNeonatal-Perinatal Medicine Physician10107RLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346231875
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN MANUAL BOSSANO MD
Provider Business Mailing Address
First Line : 2903 1ST AVE
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8809
Country : US
Telephone Number : 337-478-6480
Fax Number : 337-474-9637
Provider Business Practice Location Address
First Line : 2903 1ST AVE
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8809
Country : US
Telephone Number : 337-478-6480
Fax Number : 337-474-9637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 07/08/2007

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