Healthcare Provider Details

I. General information

NPI: 1366202715
Provider Name (Legal Business Name): PREFERRED PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 08/28/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 AMBASSADOR CAFFERY PKWY STE B130
LAFAYETTE LA
70508-6959
US

IV. Provider business mailing address

4540 AMBASSADOR CAFFERY PKWY STE B130
LAFAYETTE LA
70508-6959
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-8486
  • Fax: 337-988-6816
Mailing address:
  • Phone: 337-981-8486
  • Fax: 337-988-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMAKRISHNA KASINDULA
Title or Position: MD/OWNER
Credential: MD
Phone: 337-981-8486