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NPI Code Detail

MEDICARE: MEDICAL & OCCUPATIONAL CLINIC OF LAKE CHARLES, L.L.C.

MEDICARE: MEDICAL & OCCUPATIONAL CLINIC OF LAKE CHARLES, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467406926
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL & OCCUPATIONAL CLINIC OF LAKE CHARLES, L.L.C.
Provider Business Mailing Address
First Line : 2770 3RD AVE
Second Line : SUITE 225
City : LAKE CHARLES
State : LA
Zip : 70601-8994
Country : US
Telephone Number : 337-478-2573
Fax Number : 337-478-5296
Provider Business Practice Location Address
First Line : 2770 3RD AVE
Second Line : SUITE 225
City : LAKE CHARLES
State : LA
Zip : 70601-8994
Country : US
Telephone Number : 337-478-2573
Fax Number : 337-478-5296
Authorized Official
Title or Position : MANAGER
Name : DR. LIWLIWA QUITORIANO RAMOS
Credential :
Telephone Number : 337-478-2573
Provider Enumeration Date : 05/20/2006
Last Update Date : 08/22/2020

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