Healthcare Provider Details

I. General information

NPI: 1750811089
Provider Name (Legal Business Name): RADIANT NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 UNITED PLAZA BLVD BLDG STE 305
BATON ROUGE LA
70809-2256
US

IV. Provider business mailing address

1141 N LOOP 1604 E # 105-612
SAN ANTONIO TX
78232-1339
US

V. Phone/Fax

Practice location:
  • Phone: 854-202-8292
  • Fax:
Mailing address:
  • Phone: 854-202-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROXANNA LAROQUE
Title or Position: DIRECTOR, CLIENT EXPERIENCE
Credential:
Phone: 210-598-2800