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NPI Code Detail

MEDICARE: GERALDLYN BROUSSARD

MEDICARE: GERALDLYN BROUSSARD
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
1106S00000XBehavior TechnicianLA

General Provider Information

NPI Number : 1821650151
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERALDLYN BROUSSARD
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 209 CENTRE SARCELLE BLVD STE 201
Second Line :
City : YOUNGSVILLE
State : LA
Zip : 70592-6755
Country : US
Telephone Number : 337-573-1084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2019
Last Update Date : 07/08/2019

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Directions to “ GERALDLYN BROUSSARD ” Practice Location

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