Healthcare Provider Details

I. General information

NPI: 1528774023
Provider Name (Legal Business Name): CHILDRENS HEART CLINIC OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 CAMELLIA BLVD STE 101
LAFAYETTE LA
70508-7248
US

IV. Provider business mailing address

1003 CAMELLIA BLVD STE 101
LAFAYETTE LA
70508-7248
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6892
  • Fax:
Mailing address:
  • Phone: 337-456-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DURGA NAIDU
Title or Position: MD
Credential:
Phone: 337-456-6892