Healthcare Provider Details

I. General information

NPI: 1912568791
Provider Name (Legal Business Name): KAI CAPDAU QUITZAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 GALLERIA DR STE 201
METAIRIE LA
70001-2196
US

IV. Provider business mailing address

3100 GALLERIA DR STE 201
METAIRIE LA
70001-2196
US

V. Phone/Fax

Practice location:
  • Phone: 504-315-4247
  • Fax: 504-814-9765
Mailing address:
  • Phone: 504-315-4247
  • Fax: 504-814-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number312688
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: