Healthcare Provider Details

I. General information

NPI: 1013679810
Provider Name (Legal Business Name): DR. NISHA MANILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

1100 FLORIDA AVENUE, BOX 7
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberP-192
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: