Organization
DEEPBLUE WELLNESS LLC
Active
Parent organization
NICOLAS VERGARA MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
NICOLAS VERGARA MD
Authorized official
NICOLAS VERGARA MD (OWNER)
(504) 275-4489
Entity
Organization
Contact information
Practice address
4421 CONLIN ST STE 101, METAIRIE, LA 70006-2145
(337) 643-8424
(337) 643-8407
Mailing address
PO BOX 85, KAPLAN, LA 70548-0085
(337) 643-8424
(337) 643-8407
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
MD.204964
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507814
—
LA
Enumeration date
03/09/2018
Last updated
03/09/2018
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