Healthcare Provider Details

I. General information

NPI: 1700402153
Provider Name (Legal Business Name): CARDIOMED CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 AUTUMN PL
MANDEVILLE LA
70471-6773
US

IV. Provider business mailing address

811 AUTUMN PL
MANDEVILLE LA
70471-6773
US

V. Phone/Fax

Practice location:
  • Phone: 985-256-5599
  • Fax: 985-256-5687
Mailing address:
  • Phone: 985-674-8430
  • Fax: 985-256-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD COLON-ORTIZ
Title or Position: MD/OWNER
Credential: MD
Phone: 985-674-8430