Healthcare Provider Details

I. General information

NPI: 1285650200
Provider Name (Legal Business Name): LUISA C BACUTA-TAGORDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ACADIA DRIVE
RACELAND LA
70394
US

IV. Provider business mailing address

110 ACADIA DRIVE
RACELAND LA
70394
US

V. Phone/Fax

Practice location:
  • Phone: 985-537-8687
  • Fax: 985-537-8976
Mailing address:
  • Phone: 985-537-8687
  • Fax: 985-537-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-08233R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number08233R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: