1265467468 NPI number — CHRISTIAN R LE BIENVENU M D PA

Table of content: (NPI 1265467468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265467468 NPI number — CHRISTIAN R LE BIENVENU M D PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN R LE BIENVENU M D PA
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:
Provider Other Organization Name Type Code:
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:
1265467468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901CORAL HILLS DRIVE
Provider Second Line Business Mailing Address:
SUITE 390
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-796-8181
Provider Business Mailing Address Fax Number:
954-796-8191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901CORAL HILLS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 390
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-796-8181
Provider Business Practice Location Address Fax Number:
954-796-8191
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LE BIENVENU
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
ROGER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-796-8181

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12187 . This is a "BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 005767 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107312 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 293595 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2556568004 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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