1821293762 NPI number — SONJA LYNETTE BEN

Table of content: SONJA LYNETTE BEN (NPI 1821293762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821293762 NPI number — SONJA LYNETTE BEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEN
Provider First Name:
SONJA
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1821293762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3848 SUE KER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70058-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-341-7818
Provider Business Mailing Address Fax Number:
504-367-7725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 WESTBANK EXPY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-367-7724
Provider Business Practice Location Address Fax Number:
504-367-7725
Provider Enumeration Date:
06/20/2007

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: 251J00000X , with the licence number:  7151 , 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)

  • Identifier: 1015466 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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