Organization
ZACHARY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELENITA P SANTOS-MATA M.D. (OWNER)
(225) 658-7636
Entity
Organization
Contact information
Practice address
4851 W PARK DR, SUITE A, ZACHARY, LA 70791-4010
(225) 658-7636
Mailing address
4851 W PARK DR, SUITE A, ZACHARY, LA 70791-4010
(225) 658-7636
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
07399R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1372617
—
LA
Enumeration date
06/24/2008
Last updated
06/24/2008
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