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General NPI Number Information
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NPI Number | 1831143437
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Entity Type | Organization
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Legal Business Name | CRITICAL CARE NEWBORN SERVICES
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1214 COOLIDGE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2621
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Country | US
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Telephone | 337-984-7828
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Fax | 337-984-7828
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Provider Business Mailing Address
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Address Line | PO BOX 51393
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City | LAFAYETTE
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State | LA
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Zip | 70505-1393
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Country | US
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Telephone | 337-984-7828
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Fax | 337-984-7828
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MARK DE IULIO
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Credential | MD
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Telephone | 337-984-7828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 200453
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License Number State | LA
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