Healthcare Provider Details

I. General information

NPI: 1679401376
Provider Name (Legal Business Name): BRANDON ROMBACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WICHERS DR STE 206
MARRERO LA
70072-3054
US

IV. Provider business mailing address

1514 6TH ST
NEW ORLEANS LA
70115-3331
US

V. Phone/Fax

Practice location:
  • Phone: 504-645-5506
  • Fax: 888-400-9860
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: