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General NPI Number Information
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NPI Number | 1619351780
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Entity Type | Individual
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Provider Name | MINA SOURIAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1214 COOLIDGE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70503-2621
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Country | US
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Telephone | 845-729-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 COOLIDGE ST
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City | LAFAYETTE
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State | LA
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Zip | 70503
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Country | US
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Telephone | 845-729-4722
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Fax |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A179351
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A179351
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 323438
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 323438
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License Number State | LA
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