Healthcare Provider Details

I. General information

NPI: 1699593830
Provider Name (Legal Business Name): CANYON DARCY CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NAPOLEON AVE
NEW ORLEANS LA
70115-6914
US

IV. Provider business mailing address

2700 NAPOLEON AVE
NEW ORLEANS LA
70115-6914
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number343919
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: