Provider Demographics
NPI:1124762299
Name:CORDOVA ARTISTRY LLC
Entity type:Organization
Organization Name:CORDOVA ARTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOFTON
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED COSMETOLOGI
Authorized Official - Phone:504-344-5612
Mailing Address - Street 1:2673 SEA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3926 BARRON ST STE 19
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5797
Practice Address - Country:US
Practice Address - Phone:504-344-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies