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Contact Information

CCP MEDICAL MANAGEMENT, LLC
213 FOURPARK RD
SUITE C
LAFAYETTE, LA70507-2481
 Phone: 337-896-6400
 Fax: 337-896-6441
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

208VP0000X 72 Physician/Pain Management
Indicates primary specialty

NPI Profile & details for CCP MEDICAL MANAGEMENT LLC · (Female)

NPI Number 1740466440
Status Active
Credentials
Entity Individual
Enumeration date 01/14/2008
Last updated 01/14/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • LA License # 026036
  • LA Medicaid 1447692
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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