Healthcare Provider Details

I. General information

NPI: 1295790723
Provider Name (Legal Business Name): ABDOLREZA VADIEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date: 05/15/2018
Reactivation Date: 10/31/2018

III. Provider practice location address

125 E SAINT BERNARD HWY
CHALMETTE LA
70043-5159
US

IV. Provider business mailing address

125 E SAINT BERNARD HWY
CHALMETTE LA
70043-5159
US

V. Phone/Fax

Practice location:
  • Phone: 504-278-1414
  • Fax: 504-278-1455
Mailing address:
  • Phone: 504-278-1414
  • Fax: 504-278-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number023512
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number023512
License Number StateLA

VIII. Authorized Official

Name: DR. ABDOLREZA VADIEE
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 504-278-1414