Healthcare Provider Details

I. General information

NPI: 1386060432
Provider Name (Legal Business Name): BREATHE EASY ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER BLVD SUITE N 804
MARRERO LA
70072-3151
US

IV. Provider business mailing address

1111 MEDICAL CENTER BLVD SUITE N 804
MARRERO LA
70072-3151
US

V. Phone/Fax

Practice location:
  • Phone: 504-934-8777
  • Fax: 504-934-8778
Mailing address:
  • Phone: 504-934-8777
  • Fax: 504-934-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SONIA KAMBOJ
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 504-934-8777