Individual
MARIO KAKAZU
Active
Individual
MARIO KAKAZU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
05311R
LA
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD.05311R
LA
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1317128
—
LA
01
—
G6438
BLUECROSS BLUESHIELD
LA
Enumeration date
01/16/2006
Last updated
06/30/2021
Update your record
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