Provider Demographics
NPI:1750584397
Name:LA DHH-OPH-IMMUNIZATION PROGRAM
Entity type:Organization
Organization Name:LA DHH-OPH-IMMUNIZATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMMUNIZATION PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:504-838-5300
Mailing Address - Street 1:1450 L AND A RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-6235
Mailing Address - Country:US
Mailing Address - Phone:504-838-5300
Mailing Address - Fax:504-838-5206
Practice Address - Street 1:1450 L AND A RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-6235
Practice Address - Country:US
Practice Address - Phone:504-838-5300
Practice Address - Fax:504-838-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10550Medicare ID - Type Unspecified