Provider Demographics
NPI:1316170780
Name:LABRUZZO, VICTORIA MILLER
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MILLER
Last Name:LABRUZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 HOUMA BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2903
Mailing Address - Country:US
Mailing Address - Phone:504-883-2968
Mailing Address - Fax:504-883-2973
Practice Address - Street 1:4204 HOUMA BLVD
Practice Address - Street 2:FL 2
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2903
Practice Address - Country:US
Practice Address - Phone:504-883-2968
Practice Address - Fax:504-883-2973
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1805718Medicaid
LA421696YT3RMedicare PIN
LA3B302Medicare PIN