Organization
PET CENTER OF LOUISIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERTO MARTINEZ JR. MD (PARTNER)
(504) 887-8728
Entity
Organization
Contact information
Practice address
1495 GAUSE BLVD, SLIDELL, LA 70458-2205
(504) 887-8728
(504) 887-8702
Mailing address
PO BOX 6315, METAIRIE, LA 70009-6315
(985) 345-8867
(985) 542-5322
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
445353
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441520
—
LA
Enumeration date
06/21/2005
Last updated
08/22/2020
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