NPI 1295272623

Exotic Expressions INC.

Organisation Exclusive Provider Organization Breaux Bridge, LA

Practice location

Address: 729 Cecile Blvd, Breaux Bridge, LA 70517-5707
Phone: (337) 376-0473
Mailing address: 729 Cecile Blvd Bldg A- 1, Breaux Bridge, LA 70517-5707

Authorised official

Name: Shana Madalyn Wiltz
Title: Ceo
Phone: (337) 376-0473

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 11041986 (LA)

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Registry record

NPI: 1295272623
Entity type: Organization
NPI issued: 24 Jan 2017
Record last updated: 24 Jan 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.