Provider Information for 1639764426
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MIRFAT ADDI
Sex: Female
NPI: 1639764426
Last Updated: 2024-03-19
Certification Date: 2024-03-19
Certification Date: 2024-03-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639764426 | ||||||||
| Enumeration Date | 2021-03-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3420 W PARC GREEN ST HARVEY, LA 70058-7042 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 3420 W PARC GREEN ST HARVEY, LA 70058-7042 United States Phone: 504-446-4378 | Fax: | ||||||||
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