Provider Demographics
NPI:1174095004
Name:PRIMO, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:PRIMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43166 RUGER DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0870
Mailing Address - Country:US
Mailing Address - Phone:985-778-7885
Mailing Address - Fax:
Practice Address - Street 1:1126 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5972
Practice Address - Country:US
Practice Address - Phone:985-956-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator