1245621176 NPI number — MISS ELENA WHITNEY BENEZECH R.D., L.D.N.

Table of content: MISS ELENA WHITNEY BENEZECH R.D., L.D.N. (NPI 1245621176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245621176 NPI number — MISS ELENA WHITNEY BENEZECH R.D., L.D.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENEZECH
Provider First Name:
ELENA
Provider Middle Name:
WHITNEY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
R.D., L.D.N.
Provider Gender Code:
F

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:
1245621176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 GAUSE BLVD E STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70461-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 GAUSE BLVD E
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70461-5442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-661-3542
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  2337 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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