Healthcare Provider Details

I. General information

NPI: 1265521710
Provider Name (Legal Business Name): FIDEL FABIAN SENDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PRESCOTT RD STE 312
ALEXANDRIA LA
71301-3984
US

IV. Provider business mailing address

PO BOX 321359
FLOWOOD MS
39232-1359
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-0490
  • Fax:
Mailing address:
  • Phone: 601-936-1395
  • Fax: 601-933-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number13230R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: