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General NPI Number Information
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NPI Number | 1093711426
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Entity Type | Organization
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Legal Business Name | PET CENTER OF LOUISIANA LLC
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1495 GAUSE BLVD
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City | SLIDELL
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State | LA
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Zip | 70458-2205
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Country | US
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Telephone | 504-887-8728
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Fax | 504-887-8702
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Provider Business Mailing Address
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Address Line | PO BOX 6315
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City | METAIRIE
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State | LA
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Zip | 70009-6315
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Country | US
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Telephone | 985-345-8867
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Fax | 985-542-5322
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERTO MARTINEZ JR.
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Credential | MD
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Telephone | 504-887-8728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 445353
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License Number State | LA
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