Individual
LISA TEBAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11650 WEST BARRINGTON DR, NEW ORLEANS, LA 70128
(504) 221-9531
Mailing address
PO BOX 29561, NEW ORLEANS, LA 70189-0561
(504) 221-9531
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Enumeration date
02/10/2015
Last updated
03/19/2015
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