Healthcare Provider Details

I. General information

NPI: 1932160686
Provider Name (Legal Business Name): PAULETTE BENINATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CAROL SUE AVE SUITE E
GRETNA LA
70056-5100
US

IV. Provider business mailing address

1581 CAROL SUE AVE SUITE E
GRETNA LA
70056-5100
US

V. Phone/Fax

Practice location:
  • Phone: 504-394-9037
  • Fax: 504-392-0973
Mailing address:
  • Phone: 504-394-9037
  • Fax: 504-392-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number3256-IR
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number039127 003256
License Number StateLA

VIII. Authorized Official

Name: MS. PAULETTE M BENINATE
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 504-394-9037