Healthcare Provider Details

I. General information

NPI: 1962678144
Provider Name (Legal Business Name): SOUTHERN FERTILITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD
LULING LA
70070-4349
US

IV. Provider business mailing address

3121 TOLMAS DR
METAIRIE LA
70002-5031
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-4211
  • Fax:
Mailing address:
  • Phone: 985-785-5610
  • Fax: 985-785-3779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD06325R
License Number StateLA

VIII. Authorized Official

Name: DR. SHAILAJA RAJ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 985-785-5610