Provider Demographics
NPI:1376092452
Name:TRIEU DERMATOLOGY LLC
Entity Type:Organization
Organization Name:TRIEU DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-390-1156
Mailing Address - Street 1:1525 LAPALCO BLVD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 LAPALCO BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5738
Practice Address - Country:US
Practice Address - Phone:504-390-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203192207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty