Organization
CHILDRENS CLINIC OF RACELAND LLC
Active
Other names
CHILDRENS CLINIC OF RACELAND
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUISA CUARIO BACUTA-TAGORDA MD (MEMBER MANAGER)
(985) 537-8687
Entity
Organization
Contact information
Practice address
110 ACADIA PARK DR, RACELAND, LA 70394-2618
(985) 537-8687
(985) 537-8976
Mailing address
110 ACADIA PARK DR, RACELAND, LA 70394-2618
(985) 537-8687
(985) 537-8976
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
08233R
LA
261QP2300X
Primary Care Clinic/Center
08233R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1819336
—
LA
Enumeration date
06/05/2007
Last updated
03/04/2021
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