Healthcare Provider Details

I. General information

NPI: 1053806281
Provider Name (Legal Business Name): CERVEAU DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E SAINT PETER ST
CARENCRO LA
70520-4008
US

IV. Provider business mailing address

PO BOX 187
CARENCRO LA
70520-0187
US

V. Phone/Fax

Practice location:
  • Phone: 337-654-7539
  • Fax: 866-625-8448
Mailing address:
  • Phone: 337-654-7539
  • Fax: 866-625-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CHRYSTAL STELLY
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-654-7539