Healthcare Provider Details

I. General information

NPI: 1104807734
Provider Name (Legal Business Name): R & L ORTHOPEDIC SHOES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 FLORIDA BLVD
BATON ROUGE LA
70815-2404
US

IV. Provider business mailing address

11455 FLORIDA BLVD
BATON ROUGE LA
70815-2404
US

V. Phone/Fax

Practice location:
  • Phone: 225-275-2632
  • Fax: 225-275-3238
Mailing address:
  • Phone: 225-275-2632
  • Fax: 225-275-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ESTEBAN BOTELLO
Title or Position: PRESIDENT
Credential:
Phone: 225-275-2632