1649332248 NPI number — LAFAYETTE HEALTH VENTURES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649332248 NPI number — LAFAYETTE HEALTH VENTURES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAFAYETTE HEALTH VENTURES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DR. DIANA FERNANDEZ
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649332248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-289-8421
Provider Business Mailing Address Fax Number:
337-289-8423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 HOSPITAL DR.
Provider Second Line Business Practice Location Address:
STE #208
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-289-8421
Provider Business Practice Location Address Fax Number:
337-289-8423
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COMEAUX
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALLING
Authorized Official Telephone Number:
337-289-8974

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SC 25943 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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