Provider Demographics
NPI:1104807734
Name:R & L ORTHOPEDIC SHOES INC
Entity type:Organization
Organization Name:R & L ORTHOPEDIC SHOES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-275-2632
Mailing Address - Street 1:11455 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2404
Mailing Address - Country:US
Mailing Address - Phone:225-275-2632
Mailing Address - Fax:225-275-3238
Practice Address - Street 1:11455 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2404
Practice Address - Country:US
Practice Address - Phone:225-275-2632
Practice Address - Fax:225-275-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1305529Medicaid
LA1305529Medicaid