Provider Demographics
NPI:1609207463
Name:PHU, CINDY (MOT LOTR)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:PHU
Suffix:
Gender:F
Credentials:MOT LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5761 LOUIS PRIMA DR W
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2804
Mailing Address - Country:US
Mailing Address - Phone:504-402-9575
Mailing Address - Fax:
Practice Address - Street 1:5761 LOUIS PRIMA DR W
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-2804
Practice Address - Country:US
Practice Address - Phone:504-402-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist