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General NPI Number Information
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NPI Number | 1083308662
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Entity Type | Individual
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Provider Name | OLIVIA BUQUOI
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Gender | Female
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 15813 PAUL VEGA MD DR # 403
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City | HAMMOND
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State | LA
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Zip | 70403-1426
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Country | US
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Telephone | 985-230-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 276 COQUILLE LN
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City | MADISONVILLE
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State | LA
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Zip | 70447-3708
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Country | US
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Telephone | 985-590-7817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 337626
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License Number State | LA
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