Provider Demographics
NPI:1144694860
Name:SPINE SPECIALISTS OF LOUISIANA, L.L.C.
Entity type:Organization
Organization Name:SPINE SPECIALISTS OF LOUISIANA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:ISAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-3993
Mailing Address - Street 1:10629 HILLARY CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2842
Mailing Address - Country:US
Mailing Address - Phone:225-769-3993
Mailing Address - Fax:225-448-3667
Practice Address - Street 1:10629 HILLARY CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2842
Practice Address - Country:US
Practice Address - Phone:225-769-3993
Practice Address - Fax:225-448-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07385R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty