Provider Demographics
NPI:1689841595
Name:BREAUX, MARY G (CST-CFA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:BREAUX
Suffix:
Gender:F
Credentials:CST-CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2942
Mailing Address - Country:US
Mailing Address - Phone:985-537-4665
Mailing Address - Fax:
Practice Address - Street 1:218 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2768
Practice Address - Country:US
Practice Address - Phone:985-853-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant