Provider Demographics
NPI:1891523775
Name:AUGUSTUS, ANGELA BROUSSARD (CPT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BROUSSARD
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:CPT
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Other - Credentials:
Mailing Address - Street 1:5520 JOHNSTON ST STE K
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5138
Mailing Address - Country:US
Mailing Address - Phone:337-250-2062
Mailing Address - Fax:
Practice Address - Street 1:1022 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4816
Practice Address - Country:US
Practice Address - Phone:337-250-2062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy