Basic Information
| Provider Information | |||||||||
| NPI: | 1982684841 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARISTIMUNO | ||||||||
| FirstName: | GERARDO | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 OCHSNER BLVD | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704338107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858752828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1514 JEFFERSON HWY | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701212429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048424000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | MD.05073R | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | MD.05073R | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 174400000X | 05073R | LA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1312240 | 05 | LA | MEDICAID | 09854252 | 05 | MS | MEDICAID |