Healthcare Provider Details

I. General information

NPI: 1891575304
Provider Name (Legal Business Name): DOROTHEA ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1436
US

IV. Provider business mailing address

1958 INGLESIDE DR
BATON ROUGE LA
70808-1272
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2198
  • Fax: 985-230-2159
Mailing address:
  • Phone: 337-356-1065
  • Fax:

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 Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number247867
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: