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General NPI Number Information
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NPI Number | 1093276966
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Entity Type | Individual
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Provider Name | MICA GOULBOURNE MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1140 CALHOUN ST
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City | NEW ORLEANS
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State | LA
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Zip | 70118-5962
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Country | US
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Telephone | 504-896-9827
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 POYDRAS ST
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City | NEW ORLEANS
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State | LA
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Zip | 70163-1101
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Country | US
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Telephone | 504-527-9952
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Fax | 504-527-9950
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080C0008X
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Taxonomy Name | Child Abuse Pediatrics Physician
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License Number | 346102
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License Number State | LA
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