Healthcare Provider Details

I. General information

NPI: 1760504344
Provider Name (Legal Business Name): GULF COAST COMPREHENSIVE SLEEP MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1972 ORMOND BLVD SUITE B
DESTREHAN LA
70047-3818
US

IV. Provider business mailing address

1972 ORMOND BLVD SUITE B
DESTREHAN LA
70047-3818
US

V. Phone/Fax

Practice location:
  • Phone: 985-764-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateLA

VIII. Authorized Official

Name: MRS. CINDY MACK
Title or Position: OWNER TECHNICAL DIRECTOR
Credential:
Phone: 985-764-1441