Healthcare Provider Details

I. General information

NPI: 1790769958
Provider Name (Legal Business Name): DIMPLE KIRAN ZAVERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOUMA BLVD
METAIRIE LA
70006-2940
US

IV. Provider business mailing address

4315 HOUMA BLVD
METAIRIE LA
70006-2940
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-2020
  • Fax: 504-455-2013
Mailing address:
  • Phone: 504-455-2020
  • Fax: 504-455-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11261R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: