Healthcare Provider Details

I. General information

NPI: 1811402779
Provider Name (Legal Business Name): RONNIE SANFIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 QUEBEC DR
BATON ROUGE LA
70819-1840
US

IV. Provider business mailing address

3125 QUEBEC DR
BATON ROUGE LA
70819-1840
US

V. Phone/Fax

Practice location:
  • Phone: 225-268-2294
  • Fax:
Mailing address:
  • Phone: 225-268-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: