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Individual

IMMACULA SAINT-LOUIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
2005-01289
NC
208000000X
Pediatrics Physician
151877
MA
208000000X
Pediatrics Physician
Primary
2005-01289
NC
208000000X
Pediatrics Physician
D0088037
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3196209
MA
Enumeration date
09/20/2006
Last updated
03/27/2024
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