Provider Demographics
NPI:1891404141
Name:MY DOCTORS HOUSE LLC
Entity Type:Organization
Organization Name:MY DOCTORS HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:GREY RIVERIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-963-9852
Mailing Address - Street 1:9655 PERKINS RD STE C-260
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1533
Mailing Address - Country:US
Mailing Address - Phone:225-449-9606
Mailing Address - Fax:
Practice Address - Street 1:618 MAIN ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-1910
Practice Address - Country:US
Practice Address - Phone:225-449-9606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty