Healthcare Provider Details

I. General information

NPI: 1568474161
Provider Name (Legal Business Name): CD&J MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W PINHOOK RD SUITE 226
LAFAYETTE LA
70503-2455
US

IV. Provider business mailing address

920 W PINHOOK RD SUITE 226
LAFAYETTE LA
70503-2455
US

V. Phone/Fax

Practice location:
  • Phone: 337-593-8444
  • Fax: 337-593-9966
Mailing address:
  • Phone: 337-593-8444
  • Fax: 337-593-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number12067
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number12068
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number11117
License Number StateLA

VIII. Authorized Official

Name: MS. DELILAH MOUTON BROUSSARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 337-593-8444