Healthcare Provider Details

I. General information

NPI: 1114308913
Provider Name (Legal Business Name): SENTINEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-6144
US

IV. Provider business mailing address

3405 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-6144
US

V. Phone/Fax

Practice location:
  • Phone: 504-258-6721
  • Fax:
Mailing address:
  • Phone: 504-258-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP07786
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13528R
License Number StateLA

VIII. Authorized Official

Name: SEBREANA M DOMINGUE
Title or Position: OWNER
Credential: MBA
Phone: 504-258-6721