Healthcare Provider Details

I. General information

NPI: 1982055034
Provider Name (Legal Business Name): ORMOND PEDIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ORMOND CENTER CT
DESTREHAN LA
70047-2548
US

IV. Provider business mailing address

141 ORMOND CENTER CT
DESTREHAN LA
70047-2548
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-7337
  • Fax: 985-764-5333
Mailing address:
  • Phone: 985-764-7337
  • Fax: 985-764-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERI RODRIGUEZ
Title or Position: OFFICE MANAGER
Credential: MA
Phone: 985-764-7337