Provider Demographics
NPI:1225477235
Name:JUBERT, ANGELA K (MD,ABPN,ABPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:JUBERT
Suffix:
Gender:F
Credentials:MD,ABPN,ABPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 AIRLINE DR # B
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5936
Mailing Address - Country:US
Mailing Address - Phone:504-877-6607
Mailing Address - Fax:844-327-3882
Practice Address - Street 1:1901 AIRLINE DR # B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5936
Practice Address - Country:US
Practice Address - Phone:504-877-6607
Practice Address - Fax:844-327-3882
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1146762084A0401X
LA3054412084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2518674Medicaid