Healthcare Provider Details

I. General information

NPI: 1740835644
Provider Name (Legal Business Name): LETICIA ALVES ANTUNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RUE BEAUREGARD STE 202
LAFAYETTE LA
70508-3251
US

IV. Provider business mailing address

201 RUE BEAUREGARD STE 202
LAFAYETTE LA
70508-3251
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-1724
  • Fax: 318-749-7662
Mailing address:
  • Phone: 318-299-8600
  • Fax: 318-749-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number332691
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: