Healthcare Provider Details

I. General information

NPI: 1295756211
Provider Name (Legal Business Name): BERNARDO ANTONIO RUIZ-CALDERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

IV. Provider business mailing address

1340 POYDRAS ST SUITE 1640
NEW ORLEANS LA
70112-1221
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-6031
  • Fax: 504-568-6037
Mailing address:
  • Phone: 504-412-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number023208
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: