Provider Demographics
NPI:1962180133
Name:DIEGO- GASPAR, NAOMI
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:DIEGO- GASPAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 FERN AVE STE 902-903
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5739
Mailing Address - Country:US
Mailing Address - Phone:318-524-9954
Mailing Address - Fax:
Practice Address - Street 1:741 W 68TH ST STE 902
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2808
Practice Address - Country:US
Practice Address - Phone:270-989-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist