Healthcare Provider Details

I. General information

NPI: 1871124859
Provider Name (Legal Business Name): LAFAYETTE WELLNESS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 06/01/2023
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 CAMELLIA BLVD APT 3412
LAFAYETTE LA
70508-6692
US

IV. Provider business mailing address

1042 CAMELLIA BLVD APT 3412
LAFAYETTE LA
70508-6692
US

V. Phone/Fax

Practice location:
  • Phone: 787-951-1174
  • Fax:
Mailing address:
  • Phone: 787-202-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARDO CHAMAH
Title or Position: PRESIDENT
Credential: MD
Phone: 337-806-0293