Healthcare Provider Details

I. General information

NPI: 1962538678
Provider Name (Legal Business Name): JAMES A NORIEGA JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W BRENTWOOD BLVD STE 2
LAFAYETTE LA
70506-6190
US

IV. Provider business mailing address

203 W BRENTWOOD BLVD STE 2
LAFAYETTE LA
70506-6190
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-4001
  • Fax: 337-981-5148
Mailing address:
  • Phone: 337-981-4001
  • Fax: 337-981-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD234R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: