Provider Demographics
NPI:1487957015
Name:REZA HEART & VASCULAR INSTITUTE LLC
Entity type:Organization
Organization Name:REZA HEART & VASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:REZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-347-8253
Mailing Address - Street 1:1301 BARATARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3703
Mailing Address - Country:US
Mailing Address - Phone:504-347-8253
Mailing Address - Fax:504-349-6283
Practice Address - Street 1:1301 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3703
Practice Address - Country:US
Practice Address - Phone:504-347-8253
Practice Address - Fax:504-349-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09458R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1973254Medicaid
LA5R941Medicare PIN