Organization
ADULT MEDICINE AND DIAGNOSTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HANNA KALINOWSKA VAZQUEZ (OFFICE MANAGER)
(225) 647-1947
Entity
Organization
Contact information
Practice address
2211 S BURNSIDE AVE STE 4, GONZALES, LA 70737-4634
(225) 647-1947
(225) 644-3943
Mailing address
2211 S BURNSIDE AVE STE 4, GONZALES, LA 70737-4634
(225) 647-1947
(225) 644-3943
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
022083
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1495859
—
LA
Enumeration date
11/30/2011
Last updated
09/02/2016
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