Provider Demographics
NPI:1164062642
Name:HOSSAIN, PREYETA
Entity Type:Individual
Prefix:
First Name:PREYETA
Middle Name:
Last Name:HOSSAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 WELDWOOD DR APT 2308
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5839
Mailing Address - Country:US
Mailing Address - Phone:337-302-5923
Mailing Address - Fax:
Practice Address - Street 1:9441 COMMON ST STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1463
Practice Address - Country:US
Practice Address - Phone:225-923-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600964601Medicaid