Healthcare Provider Details

I. General information

NPI: 1447898333
Provider Name (Legal Business Name): CI PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 LINDBERG DR
SLIDELL LA
70458-8056
US

IV. Provider business mailing address

59101 AMBER ST
SLIDELL LA
70461-3708
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-7337
  • Fax: 844-743-3349
Mailing address:
  • Phone: 985-646-1580
  • Fax: 888-863-4274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO HERNANDEZ
Title or Position: CEO
Credential: MD
Phone: 985-646-1580