Provider Demographics
NPI:1083985576
Name:KELLER, MARGARITA HERNANDEZ (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:HERNANDEZ
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 ALANA LN
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-6559
Mailing Address - Country:US
Mailing Address - Phone:504-296-6218
Mailing Address - Fax:
Practice Address - Street 1:2908 ALANA LN
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-6559
Practice Address - Country:US
Practice Address - Phone:504-296-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA-5154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist