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General NPI Number Information
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NPI Number | 1366421562
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Entity Type | Individual
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Provider Name | MARIO KAKAZU M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 2552 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062-5538
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Country | US
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Telephone | 504-463-3002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2490
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City | MARRERO
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State | LA
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Zip | 70073-2490
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Country | US
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Telephone | 504-762-8909
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Fax | 504-328-0899
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 05311R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD.05311R
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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