Provider Demographics
NPI:1356930184
Name:EGOAVIL, LAURA ANDREA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANDREA
Last Name:EGOAVIL
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 1:422 BOUNY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2320
Mailing Address - Country:US
Mailing Address - Phone:337-356-5596
Mailing Address - Fax:
Practice Address - Street 1:422 BOUNY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2320
Practice Address - Country:US
Practice Address - Phone:337-356-5596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist