1437255593 NPI number — MRS. LISA GARZOTTO BERTHAUT RD, LDN, CDE

Table of content: MRS. LISA GARZOTTO BERTHAUT RD, LDN, CDE (NPI 1437255593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437255593 NPI number — MRS. LISA GARZOTTO BERTHAUT RD, LDN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERTHAUT
Provider First Name:
LISA
Provider Middle Name:
GARZOTTO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARZOTTO
Provider Other First Name:
LISA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LDN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437255593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 BELLE CHASE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-7033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-265-8304
Provider Business Mailing Address Fax Number:
504-309-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 BELLE CHASE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-265-8304
Provider Business Practice Location Address Fax Number:
504-309-4193
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1445 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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