Healthcare Provider Details

I. General information

NPI: 1114470309
Provider Name (Legal Business Name): ANA MARIA GAVIRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WESTBEND PKWY
NEW ORLEANS LA
70114-2458
US

IV. Provider business mailing address

2401 WESTBEND PKWY
NEW ORLEANS LA
70114-2458
US

V. Phone/Fax

Practice location:
  • Phone: 254-722-6567
  • Fax:
Mailing address:
  • Phone: 254-722-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7831
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111923
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: