Provider Demographics
NPI:1518648153
Name:RIDEAU, PASCOL
Entity Type:Individual
Prefix:MRS
First Name:PASCOL
Middle Name:
Last Name:RIDEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-0456
Mailing Address - Country:US
Mailing Address - Phone:337-308-6242
Mailing Address - Fax:866-846-7114
Practice Address - Street 1:270 COMPRESS RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-1136
Practice Address - Country:US
Practice Address - Phone:337-308-6242
Practice Address - Fax:866-846-7114
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328495246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy