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Organization

DNP-OUTPATIENT

Active
Parent organization
SOUTHEAST LOUISIANA STATE HOSPITAL
Organization subpart
Yes

Provider details

NPI number
Legal business name
SOUTHEAST LOUISIANA STATE HOSPITAL
Authorized official
PATRICIA GONZALES (C.E.O.)
(985) 626-6300
Entity
Organization

Contact information

Practice address
23515 HWY 190, MANDEVILLE, LA 70448
(985) 626-6300
(985) 626-6557
Mailing address
PO BOX 3850, MANDEVILLE, LA 70470-3850
(985) 626-6300
(985) 626-6557

Taxonomy

Speciality
Code
Description
License number
State
2084P0005X
Neurodevelopmental Disabilities Physician
Primary

Other

Enumeration date
06/17/2009
Last updated
06/17/2009
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