Healthcare Provider Details

I. General information

NPI: 1821216144
Provider Name (Legal Business Name): LADEBE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 RICHLAND AVE
LAFAYETTE LA
70508-6661
US

IV. Provider business mailing address

PO BOX 81736
LAFAYETTE LA
70598-1736
US

V. Phone/Fax

Practice location:
  • Phone: 337-291-2455
  • Fax:
Mailing address:
  • Phone: 337-291-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FEDERICO DELTORO
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 337-288-5557