Provider Demographics
NPI:1275159790
Name:CARDIOVASCULAR SPECIALTIES OF LOUISIANA LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALTIES OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-447-1075
Mailing Address - Street 1:3311 PRESCOTT RD STE 312
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3984
Mailing Address - Country:US
Mailing Address - Phone:318-528-1998
Mailing Address - Fax:
Practice Address - Street 1:3311 PRESCOTT RD STE 312
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3984
Practice Address - Country:US
Practice Address - Phone:318-528-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty