Healthcare Provider Details

I. General information

NPI: 1700380078
Provider Name (Legal Business Name): DEVYN LEILA ROHLFS RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 GAUSE BLVD E
SLIDELL LA
70461-4149
US

IV. Provider business mailing address

729 FOUCHER ST
NEW ORLEANS LA
70115-1310
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax:
Mailing address:
  • Phone: 787-431-5816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number330160
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number330160
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number330160
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: