Healthcare Provider Details

I. General information

NPI: 1275532673
Provider Name (Legal Business Name): NORTH OAKS PEDIATRIC CLINIC, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42440 PELICAN PROFESSIONAL PARK
HAMMOND LA
70403-2403
US

IV. Provider business mailing address

42440 PELICAN PROFESSIONAL PARK
HAMMOND LA
70403-2403
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-4950
  • Fax: 985-542-6089
Mailing address:
  • Phone: 985-542-4950
  • Fax: 985-542-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number013387
License Number StateLA

VIII. Authorized Official

Name: MRS. LESLIE MONISTERE
Title or Position: INSURANCE & BILLING MANAGER
Credential:
Phone: 985-542-4950