Provider Demographics
NPI:1427254358
Name:INTRIAGO, NARCISA DEL JESUS (MD)
Entity type:Individual
Prefix:
First Name:NARCISA
Middle Name:DEL JESUS
Last Name:INTRIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NARCISA
Other - Middle Name:DEL JESUS
Other - Last Name:TUMBACO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4100 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2950
Mailing Address - Country:US
Mailing Address - Phone:318-419-4745
Mailing Address - Fax:
Practice Address - Street 1:100 PINECREST DR.
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4276
Practice Address - Country:US
Practice Address - Phone:318-641-2000
Practice Address - Fax:318-641-2297
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL#026304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA29903OtherSUBSTANCE ABUSED CONTROL
LAL#026304OtherMEDICAL LICENSE
LAL#026304OtherMEDICAL LICENSE
LAH74489Medicare UPIN
BI8087101OtherDEA