Basic Information
| Provider Information | |||||||||
| NPI: | 1750038741 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUACH | ||||||||
| FirstName: | JIM | ||||||||
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| Credential: | MEDICAL TECHNOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2543 JARED LN | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700726003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043456488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 CANAL ST | ||||||||
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| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701123018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047023000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2022 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246QM0706X | CLP.203610-GEN | LA | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Pathology | Medical Technologist |
No ID Information.