Clint Jason Desoto
Individual provider Active NPI Home Modifications Contractor · Pollock, LA
NPI 1326284563 · NPPES record last updated Dec 17, 2008
Key facts
- NPI
- 1326284563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Modifications Contractor 171WH0202X
- License
- 89464 (LA)
- Practice address
- 461 Airbase Rd
Pollock, LA 71467-3549 - Phone
- (318) 715-1792
- Fax
- (318) 765-7641
- NPI assigned
- Dec 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 89464 | LA | MD | Home Modifications Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 89464 | LA | Yes |
Addresses
Primary practice location
461 Airbase Rd
Pollock, LA 71467-3549
Mailing address
461 Airbase Rd
Pollock, LA 71467-3549
Phone (318) 715-1792
Other providers in Pollock, LA
- Melissa Ann Berry
- Meghan Borne
- Christus Health Central Louisiana
- Bruce L Craig
- Mark Anthony Cross
- FCC Pollock
- Federal Bureau of Prisons
- Darius Gilbert
- Darahny Green
- Bart E Liles
All providers in Pollock, LA · Home Modifications Contractor in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.