Healthcare Provider Details

I. General information

NPI: 1205804606
Provider Name (Legal Business Name): RONNIE VINCENT TARAVELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7809 JEFFERSON HWY STE D2
BATON ROUGE LA
70809-1200
US

IV. Provider business mailing address

PO BOX 14207
BATON ROUGE LA
70898-4207
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-4668
  • Fax: 225-360-3900
Mailing address:
  • Phone: 225-767-4668
  • Fax: 225-765-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.016298
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD.016298
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: