Healthcare Provider Details

I. General information

NPI: 1386943579
Provider Name (Legal Business Name): JESSICA AYA ZAGORY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE RM 734A
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4760
  • Fax: 504-568-4633
Mailing address:
  • Phone: 504-894-5562
  • Fax: 504-896-3979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD.206700
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: