Provider Demographics
NPI:1851919005
Name:CENLA DERMATOLOGY
Entity Type:Organization
Organization Name:CENLA DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-424-5357
Mailing Address - Street 1:1587 N BOLTON AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4255
Mailing Address - Country:US
Mailing Address - Phone:615-424-5357
Mailing Address - Fax:318-933-3377
Practice Address - Street 1:1587 N BOLTON AVE STE 1300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4255
Practice Address - Country:US
Practice Address - Phone:318-933-3376
Practice Address - Fax:318-933-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty