Healthcare Provider Details

I. General information

NPI: 1376710913
Provider Name (Legal Business Name): DIANE NGAN TRIEU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 LAPALCO BLVD STE 20
HARVEY LA
70058-5738
US

IV. Provider business mailing address

1525 LAPALCO BLVD STE 20
HARVEY LA
70058-5738
US

V. Phone/Fax

Practice location:
  • Phone: 504-517-2025
  • Fax: 504-517-2027
Mailing address:
  • Phone: 504-517-2025
  • Fax: 504-517-2027

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberQ9754
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.203192
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberQ9754
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD.203192
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD.203192
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number203192
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: