1558641316 NPI number — DANIELLE MONTBRIAND PORCHE MPT

Table of content: DANIELLE MONTBRIAND PORCHE MPT (NPI 1558641316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558641316 NPI number — DANIELLE MONTBRIAND PORCHE MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORCHE
Provider First Name:
DANIELLE
Provider Middle Name:
MONTBRIAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558641316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3939 HOUMA BLVD
Provider Second Line Business Mailing Address:
SUITE 17 DOCTORS ROW
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-2931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-885-9121
Provider Business Mailing Address Fax Number:
504-885-0322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 17 DOCTORS ROW
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-885-9121
Provider Business Practice Location Address Fax Number:
504-885-0322
Provider Enumeration Date:
08/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  04251 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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