| Adult Medicine And Diagnostic Center | |
|
2211 S Burnside Ave Ste 4 Gonzales LA 70737-4634 | |
| (225) 647-1947 | |
| (225) 644-3943 |
| Full Name | Adult Medicine And Diagnostic Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 2211 S Burnside Ave Ste 4, Gonzales, Louisiana |
| Authorized Official Name and Position | Hanna Kalinowska Vazquez (OFFICE MANAGER) |
| Authorized Official Contact | 2256471947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adult Medicine And Diagnostic Center 2211 S Burnside Ave Ste 4 Gonzales LA 70737-4634 Ph: (225) 647-1947 | Adult Medicine And Diagnostic Center 2211 S Burnside Ave Ste 4 Gonzales LA 70737-4634 Ph: (225) 647-1947 |
| NPI Number | 1902173271 |
|---|---|
| Provider Enumeration Date | 11/30/2011 |
| Last Update Date | 09/02/2016 |
| Medicare PECOS PAC ID | 0840457842 |
|---|---|
| Medicare Enrollment ID | O20120202000433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902173271 | NPI | - | NPPES |
| 1495859 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 022083 (Louisiana) | Primary |
| Provider Name | Carlos Vazquez Borrero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326076266 PECOS PAC ID: 1355242470 Enrollment ID: I20040120000678 |
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