Healthcare Provider Details

I. General information

NPI: 1518586445
Provider Name (Legal Business Name): JARED LAJAUNIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15790 PAUL VEGA MD DR
HAMMOND LA
70403-1436
US

IV. Provider business mailing address

1542 TULANE AVE
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 985-345-2700
  • Fax: 985-230-6488
Mailing address:
  • Phone: 504-568-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number347548
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: