Healthcare Provider Details

I. General information

NPI: 1972524999
Provider Name (Legal Business Name): JUDITH M ZATARAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S TYLER ST
COVINGTON LA
70433
US

IV. Provider business mailing address

1121 S TYLER ST STE 5
COVINGTON LA
70433-2327
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-4555
  • Fax:
Mailing address:
  • Phone: 985-871-4212
  • Fax: 985-871-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number019981
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number019981
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: