Provider Demographics
NPI:1477534295
Name:LASALA, GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:LASALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JUDGE TANNER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7506
Mailing Address - Country:US
Mailing Address - Phone:985-867-2100
Mailing Address - Fax:985-871-1548
Practice Address - Street 1:101 JUDGE TANNER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7506
Practice Address - Country:US
Practice Address - Phone:985-867-2100
Practice Address - Fax:985-871-1548
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10402R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1967297Medicaid
F45404Medicare UPIN
LA1967297Medicaid