Individual
DOMONIQUE MCCALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2252 SNOWBIRD DR, HARVEY, LA 70058-5433
(504) 258-5695
Mailing address
2252 SNOWBIRD DR, HARVEY, LA 70058-5433
(504) 258-5695
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
000000000
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
LA
Enumeration date
09/20/2019
Last updated
09/20/2019
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