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General NPI Number Information
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NPI Number | 1346558053
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Entity Type | Organization
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Legal Business Name | OLYMPUS SOLUTIONS, INC.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 1134 S CLEARVIEW PKWY SUITE D-133
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City | HARAHAN
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State | LA
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Zip | 70123-2399
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Country | US
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Telephone | 504-676-8845
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Fax | 504-335-0740
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Provider Business Mailing Address
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Address Line | 1134 S CLEARVIEW PKWY SUITE D-133
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City | HARAHAN
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State | LA
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Zip | 70123-2399
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Country | US
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Telephone | 504-676-8845
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Fax | 504-335-0740
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Authorized Official
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Title or Position | CEO
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Name | DR. NIA K TEREZAKIS
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Credential | M.D.
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Telephone | 505-676-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 010404
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License Number State | LA
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