MEDICARE: KWANZA QUINEISE GAINES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1326674557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KWANZA QUINEISE GAINES

Provider Business Mailing Address
First Line	:	7435 ALABAMA ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70126-1303
Country	:	US
Telephone Number	:	504-606-7576
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 RIDGELAKE DR STE 200
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-3831
Country	:	US
Telephone Number	:	504-684-9478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2020
Last Update Date	:	03/19/2020

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Directions to “ KWANZA QUINEISE GAINES ” Practice Location

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