Healthcare Provider Details

I. General information

NPI: 1972145662
Provider Name (Legal Business Name): AMANDA RUIZ DGEROLAMO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD
COVINGTON LA
70433-8107
US

IV. Provider business mailing address

2013 WHITE DOVE DR
MADISONVILLE LA
70447-3058
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-2740
  • Fax:
Mailing address:
  • Phone: 504-451-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number320821
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: