Individual
DR. ELENITA P SANTOS-MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4851 W PARK DR, SUITE A, ZACHARY, LA 70791-4010
(225) 658-7636
(225) 658-7634
Mailing address
4851 W PARK DR, SUITE A, ZACHARY, LA 70791-4010
(225) 658-7636
(225) 658-7634
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
07399R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1372617
—
LA
Enumeration date
02/15/2007
Last updated
07/08/2007
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