Organization
ADULT MEDICINE INSTITUTE & DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS RUBEN VAZQUEZ M.D. (OWNER)
(225) 647-1947
Entity
Organization
Contact information
Practice address
1937 S BURNSIDE AVE, GONZALES, LA 70737-4632
(225) 647-1947
(225) 644-3943
Mailing address
1937 S BURNSIDE AVE, GONZALES, LA 70737-4632
(225) 647-1947
(225) 644-3943
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
022083
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1495859
—
LA
Enumeration date
02/23/2010
Last updated
02/23/2010
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