Healthcare Provider Details

I. General information

NPI: 1194914598
Provider Name (Legal Business Name): ARWEN EVENSTARA PODESTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 CANAL ST
NEW ORLEANS LA
70119-5945
US

IV. Provider business mailing address

1511 METAIRIE RD STE 22
METAIRIE LA
70005-3938
US

V. Phone/Fax

Practice location:
  • Phone: 504-252-0026
  • Fax: 504-322-3854
Mailing address:
  • Phone: 504-252-0026
  • Fax: 504-533-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200907
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number2010369
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: