Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD10473R | LA |
NPI | 1053302273 |
---|---|
Provider Name | Mrs. Diane Loria Rose |
First Address | Metairie, LA 70001-2458 |
Second Address | Metairie, LA 70001-2458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49048 | (05) | LA |
G08546 | (02) |