Healthcare Provider Details

I. General information

NPI: 1306575311
Provider Name (Legal Business Name): EAJ SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 LOVELAND ST
METAIRIE LA
70006-3921
US

IV. Provider business mailing address

5241 LOVELAND ST
METAIRIE LA
70006-3921
US

V. Phone/Fax

Practice location:
  • Phone: 504-669-6270
  • Fax:
Mailing address:
  • Phone: 504-669-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: EDGARDO ARTURO JAVIER
Title or Position: OWNER
Credential: CSFA
Phone: 504-669-6270