Healthcare Provider Details

I. General information

NPI: 1093702367
Provider Name (Legal Business Name): SUNSET MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 NAPOLEON AVENUE
SUNSET LA
70584-6100
US

IV. Provider business mailing address

990 NAPOLEON AVENUE
SUNSET LA
70584-6100
US

V. Phone/Fax

Practice location:
  • Phone: 337-662-7290
  • Fax:
Mailing address:
  • Phone: 337-662-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDY JAMES DAIGLE
Title or Position: PARTNER/MD
Credential: MD
Phone: 337-662-7290