Provider Demographics
NPI:1629023908
Name:REDILLAS, CAROL R (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:R
Last Name:REDILLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2116 PAKENHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4722
Mailing Address - Country:US
Mailing Address - Phone:504-301-1468
Mailing Address - Fax:504-301-2934
Practice Address - Street 1:2116 PAKENHAM DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4722
Practice Address - Country:US
Practice Address - Phone:504-301-1468
Practice Address - Fax:504-301-2934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15249R2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1172600Medicaid
LA1172600Medicaid
LA4F633Medicare ID - Type Unspecified