Healthcare Provider Details

I. General information

NPI: 1477823144
Provider Name (Legal Business Name): RAUL LLANOS, MD PMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
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 Code207VG0400X
TaxonomyGynecology Physician
License Number13578
License Number StateLA

VIII. Authorized Official

Name: DR. RAUL LLANOS
Title or Position: PRESIDENT
Credential: MD
Phone: 504-834-1050