Healthcare Provider Details

I. General information

NPI: 1750388757
Provider Name (Legal Business Name): CYNTHIA LOUISE MIZGALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S I 10 SERVICE RD W SUITE 105
METAIRIE LA
70001-7404
US

IV. Provider business mailing address

4720 S I 10 SERVICE RD W SUITE 105
METAIRIE LA
70001-7404
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-4515
  • Fax: 504-885-8394
Mailing address:
  • Phone: 504-885-4515
  • Fax: 504-885-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10047R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: