1255782330 NPI number — MRS. JAIME RICHARD MACALUSO APRN

Table of content: GEORGE DUNEA MD (NPI 1639176746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255782330 NPI number — MRS. JAIME RICHARD MACALUSO APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACALUSO
Provider First Name:
JAIME
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255782330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-503-6791
Provider Business Mailing Address Fax Number:
504-393-2744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4315 HOUMA BLVD SUITE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-889-5250
Provider Business Practice Location Address Fax Number:
504-889-5288
Provider Enumeration Date:
06/29/2016

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: 163W00000X , with the licence number:  RN129789 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: AP08817 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP08817 , 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)