Provider Demographics
NPI:1285745729
Name:LAREDO HOME INFUSION
Entity type:Organization
Organization Name:LAREDO HOME INFUSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIGLIAZZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:956-794-8350
Mailing Address - Street 1:1610 E BUSTAMANTE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5455
Mailing Address - Country:US
Mailing Address - Phone:956-794-8350
Mailing Address - Fax:
Practice Address - Street 1:1610 E BUSTAMANTE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5455
Practice Address - Country:US
Practice Address - Phone:956-794-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2437218Medicaid
TX145622OtherTEXAS VENDOR DRUG PROGRAM
TX4508694OtherNCPDP
TX5570230002Medicare NSC