Healthcare Provider Details

I. General information

NPI: 1154923167
Provider Name (Legal Business Name): LAURA CANEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 MANHATTAN BLVD STE 304
HARVEY LA
70058-5341
US

IV. Provider business mailing address

3030 EDENBORN AVE APT 121
METAIRIE LA
70002-4766
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-6830
  • Fax: 504-208-1900
Mailing address:
  • Phone: 347-520-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10906
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: