Healthcare Provider Details

I. General information

NPI: 1083874192
Provider Name (Legal Business Name): REBECCA D SOINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15709 PROFESSIONAL PLZ
HAMMOND LA
70403-1452
US

IV. Provider business mailing address

1587 N BOLTON AVE STE 1300
ALEXANDRIA LA
71303-4255
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-9333
  • Fax:
Mailing address:
  • Phone: 254-739-5744
  • Fax: 318-933-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number203925
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: