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General NPI Number Information
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NPI Number | 1457501686
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Entity Type | Organization
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Legal Business Name | JUAN J PEREZ RUIZ M.D. A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 461 HEYMANN BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2616
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Country | US
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Telephone | 337-289-8717
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Fax | 337-289-8718
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Provider Business Mailing Address
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Address Line | 461 HEYMANN BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2616
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Country | US
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Telephone | 337-289-8717
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Fax | 337-289-8718
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Authorized Official
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Title or Position | OWNER
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Name | JUAN JOSE PEREZ RUIZ
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Credential | M.D.
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Telephone | 337-289-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 022070
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License Number State | LA
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