Healthcare Provider Details

I. General information

NPI: 1730486382
Provider Name (Legal Business Name): RELIAPATH LLC A PROFESSIONAL MEDICAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 BERTRAND DR
LAFAYETTE LA
70506-2055
US

IV. Provider business mailing address

1810 BERTRAND DR
LAFAYETTE LA
70506-2055
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-1899
  • Fax: 337-233-1923
Mailing address:
  • Phone: 337-233-1899
  • Fax: 337-233-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA D ALTMANN
Title or Position: AUTHORIZED REPRESENTATIVE/OWNER
Credential: M.D.
Phone: 337-365-5944