Healthcare Provider Details

I. General information

NPI: 1033343793
Provider Name (Legal Business Name): DR.EDUARDO CHAMAH OFICINA MEDICA , C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 CAMELLIA BLVD APT 3412
LAFAYETTE LA
70508-6692
US

IV. Provider business mailing address

1042 CAMELLIA BLVD APT 3412
LAFAYETTE LA
70508-6692
US

V. Phone/Fax

Practice location:
  • Phone: 337-806-0293
  • Fax:
Mailing address:
  • Phone: 337-806-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number10266
License Number StatePR

VIII. Authorized Official

Name: EDUARDO M CHAMAH
Title or Position: PRESIDENT
Credential:
Phone: 337-806-0293