Provider Demographics
NPI:1326674557
Name:GAINES, KWANZA QUINEISE
Entity Type:Individual
Prefix:
First Name:KWANZA
Middle Name:QUINEISE
Last Name:GAINES
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 1:7435 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1303
Mailing Address - Country:US
Mailing Address - Phone:504-606-7576
Mailing Address - Fax:
Practice Address - Street 1:3350 RIDGELAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3831
Practice Address - Country:US
Practice Address - Phone:504-684-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty