Healthcare Provider Details

I. General information

NPI: 1497716419
Provider Name (Legal Business Name): RAUL LLANOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3749 N CAUSEWAY BLVD SUITE C
METAIRIE LA
70002-1740
US

IV. Provider business mailing address

3749 N CAUSEWAY BLVD SUITE C
METAIRIE LA
70002-1740
US

V. Phone/Fax

Practice location:
  • Phone: 504-834-1050
  • Fax: 504-828-0570
Mailing address:
  • Phone: 504-834-1050
  • Fax: 504-828-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number013578
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: