Healthcare Provider Details

I. General information

NPI: 1154670305
Provider Name (Legal Business Name): BRITTANY BROCATO CST, CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13513 GENERAL OTT RD
HAMMOND LA
70403-3205
US

IV. Provider business mailing address

13513 GENERAL OTT RD
HAMMOND LA
70403-3205
US

V. Phone/Fax

Practice location:
  • Phone: 985-974-3423
  • Fax:
Mailing address:
  • Phone: 985-974-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number135414
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: