Healthcare Provider Details

I. General information

NPI: 1417239138
Provider Name (Legal Business Name): MRS. KRISTEN CATALANOTTO GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 HIGHWAY 59
MANDEVILLE LA
70471-1936
US

IV. Provider business mailing address

2803 HIGHWAY 59
MANDEVILLE LA
70471-1936
US

V. Phone/Fax

Practice location:
  • Phone: 985-626-0234
  • Fax: 985-626-0227
Mailing address:
  • Phone: 985-626-0234
  • Fax: 985-626-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019107
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: