Healthcare Provider Details

I. General information

NPI: 1588645303
Provider Name (Legal Business Name): TCHEFUNCTE CARDIOVASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E FAIRWAY DR SUITE 504
COVINGTON LA
70433-7503
US

IV. Provider business mailing address

101 E FAIRWAY DR SUITE 504
COVINGTON LA
70433-7503
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-8227
  • Fax: 985-871-6920
Mailing address:
  • Phone: 985-871-8227
  • Fax: 985-871-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL LASALA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 985-871-8227