Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 6079 | LA |
NPI | 1316699762 |
---|---|
Provider Name | Angele Marie Sirgo |
First Address | New Orleans, LA 70124-1325 |
Second Address | Mandeville, LA 70448-1960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2022 |
Last Update Date | 26/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q037115 | (05) | TN |