Organization
NEUROMEDICAL CLINIC OF CENLA,L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GONZALO IVAR HIDALGO M.D. (OWNER/PHYSICIAN)
(318) 443-0490
Entity
Organization
Contact information
Practice address
3311 PRESCOTT RD, SUITE 216, ALEXANDRIA, LA 71301-3900
(318) 443-0490
(318) 443-0690
Mailing address
3311 PRESCOTT RD, SUITE 216, ALEXANDRIA, LA 71301-3900
(318) 443-0490
(318) 443-0690
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
025214
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1108162
—
LA
Enumeration date
06/23/2008
Last updated
06/23/2008
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