Provider Demographics
NPI:1871284646
Name:VIJ, PRACHI (LAC)
Entity type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:VIJ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-1612
Mailing Address - Country:US
Mailing Address - Phone:504-723-3463
Mailing Address - Fax:
Practice Address - Street 1:2901 RIDGELAKE DR STE 109
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4946
Practice Address - Country:US
Practice Address - Phone:504-285-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist