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General NPI Number Information
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NPI Number | 1528244811
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Entity Type | Organization
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Legal Business Name | CENTER FOR LONGEVITY AND WELLNESS
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 3601 HOUMA BLVD SUITE 300
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City | METAIRIE
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State | LA
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Zip | 70006-4326
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Country | US
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Telephone | 504-885-7360
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Fax | 504-885-1360
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Provider Business Mailing Address
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Address Line | 3601 HOUMA BLVD SUITE 300
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City | METAIRIE
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State | LA
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Zip | 70006-4326
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Country | US
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Telephone | 504-885-7360
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Fax | 504-885-1360
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MISS TIFFANY ROBERTS SCHACHERL
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Credential |
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Telephone | 504-885-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 012129
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License Number State | LA
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