MEDICARE: ZACHARY PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	07399R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194986893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACHARY PEDIATRICS

Provider Business Mailing Address
First Line	:	4851 W PARK DR
Second Line	:	SUITE A
City	:	ZACHARY
State	:	LA
Zip	:	70791-4010
Country	:	US
Telephone Number	:	225-658-7636
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 W PARK DR
Second Line	:	SUITE A
City	:	ZACHARY
State	:	LA
Zip	:	70791-4010
Country	:	US
Telephone Number	:	225-658-7636
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELENITA P SANTOS-MATA
Credential	:	M.D.
Telephone Number	:	225-658-7636

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

Similar Medicare Providers

1053454108 — DR. ELENITA P SANTOS-MATA M.D.
Practice Location Address:

4851 W PARK DR , SUITE A
ZACHARY, LA
70791-4010

Practice Phone: 225-658-7636
Practice Fax: 225-658-7634

1871623538 — REBECCA WICKLIFFE RNFA
Practice Location Address:

4851 W PARK DR , SUITE B
ZACHARY, LA
70791-4010

Practice Phone: 225-654-0310
Practice Fax: 225-654-0310

1619802337 — CAMRYN BROUILLETTE
Practice Location Address:

4845 MAIN ST STE C
ZACHARY, LA
70791-3943

Practice Phone: 225-286-0181
Practice Fax: 225-286-0186

1477489516 — MRS. HAYLEY T BORDES PT, DPT
Practice Location Address:

1219 CHURCH ST
ZACHARY, LA
70791-2347

Practice Phone: 225-658-7751
Practice Fax: 225-658-7753

1326612821 — LAUREN MALIK CANADY
Practice Location Address:

9305 MAIN ST
ZACHARY, LA
70791-7441

Practice Phone: 225-278-1020
Practice Fax:

1780517631 — JACELYN HASTINGS
Practice Location Address:

1215 INDEPENDENCE BLVD BLDG 6
ZACHARY, LA
70791-7390

Practice Phone: 225-286-1547
Practice Fax:

Directions to “ZACHARY PEDIATRICS ” Practice Location

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