Healthcare Provider Details

I. General information

NPI: 1396040994
Provider Name (Legal Business Name): SOLA PAIN CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 VETERANS MEMORIAL BLVD STE 102
KENNER LA
70062-4003
US

IV. Provider business mailing address

1919 VETERANS MEMORIAL BLVD STE 102
KENNER LA
70062-4003
US

V. Phone/Fax

Practice location:
  • Phone: 504-461-9009
  • Fax: 504-461-9170
Mailing address:
  • Phone: 504-461-9009
  • Fax: 504-461-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CIRO CERRATO
Title or Position: OWNER
Credential:
Phone: 504-461-9009