Healthcare Provider Details

I. General information

NPI: 1740119239
Provider Name (Legal Business Name): PANDORA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 STANLEY ROBERT RD
BREAUX BRIDGE LA
70517-7914
US

IV. Provider business mailing address

1008 STANLEY ROBERT RD
BREAUX BRIDGE LA
70517-7914
US

V. Phone/Fax

Practice location:
  • Phone: 832-631-3362
  • Fax:
Mailing address:
  • Phone: 832-631-3362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number010115272
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: