Healthcare Provider Details

I. General information

NPI: 1124565296
Provider Name (Legal Business Name): SOLA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LIBERTY AVE
LAFAYETTE LA
70508
US

IV. Provider business mailing address

4650 AMBASSADOR CAFFERY PKWY STE 105
LAFAYETTE LA
70508-6926
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-8080
  • Fax: 337-981-0913
Mailing address:
  • Phone: 337-989-8080
  • Fax: 337-981-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD WARREN PRATT
Title or Position: OWNER
Credential: M.D.
Phone: 337-989-8080