Healthcare Provider Details

I. General information

NPI: 1083554851
Provider Name (Legal Business Name): DIANA K. CLAVIN, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 ROBERT BLVD SUITE 220
SIDELL LA
70458
US

IV. Provider business mailing address

1150 ROBERT BLVD SUITE 220
SIDELL LA
70458
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-4848
  • Fax: 985-781-4850
Mailing address:
  • Phone: 985-781-4848
  • Fax: 985-781-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA K CLAVIN
Title or Position: OWNER
Credential: MD
Phone: 985-781-4848