Healthcare Provider Details

I. General information

NPI: 1356778039
Provider Name (Legal Business Name): HEALTHY SOLUTIONS CLINIC OF CROWLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 TOWER RD
CROWLEY LA
70526-2211
US

IV. Provider business mailing address

136 TOWER RD
CROWLEY LA
70526-2211
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-2410
  • Fax: 337-783-2412
Mailing address:
  • Phone: 337-783-2410
  • Fax: 337-783-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberMD. 12971R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberMD. 12939R
License Number StateLA

VIII. Authorized Official

Name: MR. DANIEL DE LA NUEZ
Title or Position: OWNER
Credential:
Phone: 337-783-2410