Healthcare Provider Details

I. General information

NPI: 1134180011
Provider Name (Legal Business Name): ESCIPION PEDROZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CANNES DR
LA PLACE LA
70068-2407
US

IV. Provider business mailing address

1700 CANNES DR
LA PLACE LA
70068-2407
US

V. Phone/Fax

Practice location:
  • Phone: 985-658-1689
  • Fax: 985-652-1778
Mailing address:
  • Phone: 985-658-1689
  • Fax: 985-652-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberM.D.05646R
License Number StateLA

VIII. Authorized Official

Name: TERRY L BOZEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-454-2260