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General NPI Number Information
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NPI Number | 1588735393
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Entity Type | Organization
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Legal Business Name | THE PRIMARY CARE GROUP OF EAST JEFFERSON, LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4315 HOUMA BLVD SUITE 204
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City | METAIRIE
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State | LA
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Zip | 70006-2940
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Country | US
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Telephone | 504-454-5396
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Fax | 504-456-8151
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Provider Business Mailing Address
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Address Line | 4420 CONLIN ST SUITE 304
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City | METAIRIE
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State | LA
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Zip | 70006-2167
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Country | US
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Telephone | 504-454-5396
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Fax | 504-456-8151
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAUREN A SANTA ANA
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Credential | MHA, MBA
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Telephone | 504-454-5396
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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 |
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License Number State |
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