Healthcare Provider Details

I. General information

NPI: 1699148882
Provider Name (Legal Business Name): BOPP DERMATOLOGY AND FACIAL PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 N CAUSEWAY BLVD 102
METAIRIE LA
70002
US

IV. Provider business mailing address

3421 N CAUSEWAY BLVD STE 102
METAIRIE LA
70002-3711
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-9933
  • Fax:
Mailing address:
  • Phone: 504-455-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number202381
License Number StateLA

VIII. Authorized Official

Name: SUE LYNN RESENDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-455-9933