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General NPI Number Information
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NPI Number | 1356066179
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Entity Type | Organization
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Legal Business Name | AESTHETIC AND BREAST RESTORATIVE CENTER, LLC
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | 6330 MOURNING DOVE DR
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City | BATON ROUGE
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State | LA
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Zip | 70817-1155
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Country | US
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Telephone | 225-277-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 732
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-0732
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Country | US
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Telephone | 225-277-7200
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Fax | 225-277-7205
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Authorized Official
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Title or Position | CEO
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Name | JILL DUPONT
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Credential |
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Telephone | 985-290-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number |
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License Number State |
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