Healthcare Provider Details

I. General information

NPI: 1992813612
Provider Name (Legal Business Name): STELLA BOUSTANY NOEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD SUITE 400
LAFAYETTE LA
70503-2638
US

IV. Provider business mailing address

1211 COOLIDGE BLVD SUITE 400
LAFAYETTE LA
70503-2638
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-9779
  • Fax: 337-235-0654
Mailing address:
  • Phone: 337-235-9779
  • Fax: 337-235-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number017731
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: