Healthcare Provider Details

I. General information

NPI: 1831695253
Provider Name (Legal Business Name): A&G PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 DIVISION ST. SUITE 206
METAIRIE LA
70002
US

IV. Provider business mailing address

3001 DIVISION ST. SUITE 206
METAIRIE LA
70002
US

V. Phone/Fax

Practice location:
  • Phone: 504-465-9898
  • Fax: 504-465-9499
Mailing address:
  • Phone: 504-465-9898
  • Fax: 504-465-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ARTURO G GASTANADUY
Title or Position: PRESIDENT
Credential: MD
Phone: 504-465-9898