Provider Demographics
NPI:1336563444
Name:CALLOURA, MARLA
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:
Last Name:CALLOURA
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 1:947 CRESWELL LN
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5819
Mailing Address - Country:US
Mailing Address - Phone:337-948-7812
Mailing Address - Fax:337-948-3461
Practice Address - Street 1:947 CRESWELL LN
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5819
Practice Address - Country:US
Practice Address - Phone:337-948-7812
Practice Address - Fax:337-948-3461
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies