Provider Demographics
NPI:1649730623
Name:BOLGIANO, VICTORIA L (DO)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:L
Last Name:BOLGIANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:206 ENERGY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3816
Mailing Address - Country:US
Mailing Address - Phone:337-504-3335
Mailing Address - Fax:337-504-4795
Practice Address - Street 1:206 ENERGY PARKWAY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3816
Practice Address - Country:US
Practice Address - Phone:337-504-3335
Practice Address - Fax:337-504-4795
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA332188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2526146Medicaid