Provider Demographics
NPI:1740771161
Name:RAYMOND, TORIE JUPITER
Entity Type:Individual
Prefix:
First Name:TORIE
Middle Name:JUPITER
Last Name:RAYMOND
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 1:309 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-2808
Mailing Address - Country:US
Mailing Address - Phone:504-261-7804
Mailing Address - Fax:504-910-8883
Practice Address - Street 1:309 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2808
Practice Address - Country:US
Practice Address - Phone:504-261-7804
Practice Address - Fax:504-910-8883
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)