Healthcare Provider Details

I. General information

NPI: 1659282499
Provider Name (Legal Business Name): INDI T MANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 BIENVILLE ST STE 100
NEW ORLEANS LA
70119-5151
US

IV. Provider business mailing address

3909 BIENVILLE ST STE 100
NEW ORLEANS LA
70119-5151
US

V. Phone/Fax

Practice location:
  • Phone: 504-826-2675
  • Fax:
Mailing address:
  • Phone: 504-826-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: