Healthcare Provider Details

I. General information

NPI: 1841782208
Provider Name (Legal Business Name): JOURNEY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11924 JUSTICE AVE STE B
BATON ROUGE LA
70816-2372
US

IV. Provider business mailing address

12025 JUSTICE AVE
BATON ROUGE LA
70816-5327
US

V. Phone/Fax

Practice location:
  • Phone: 225-218-4677
  • Fax: 225-218-4677
Mailing address:
  • Phone: 225-218-4677
  • Fax: 225-218-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number301823
License Number StateLA

VIII. Authorized Official

Name: ANGELIA HECTOR
Title or Position: OWNER
Credential:
Phone: 225-218-4677