Healthcare Provider Details

I. General information

NPI: 1275159790
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALTIES OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 312
ALEXANDRIA LA
71301-3984
US

IV. Provider business mailing address

3311 PRESCOTT RD STE 312
ALEXANDRIA LA
71301-3984
US

V. Phone/Fax

Practice location:
  • Phone: 318-528-1998
  • Fax:
Mailing address:
  • Phone: 318-528-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE DEFEO
Title or Position: ADMIN ASSIST
Credential:
Phone: 318-447-1075