Healthcare Provider Details

I. General information

NPI: 1518558485
Provider Name (Legal Business Name): TORIANA SHAVON ALFRED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 KIRKMAN ST
LAKE CHARLES LA
70601-5344
US

IV. Provider business mailing address

1409 KIRKMAN ST
LAKE CHARLES LA
70601-5344
US

V. Phone/Fax

Practice location:
  • Phone: 337-419-3586
  • Fax: 855-239-9737
Mailing address:
  • Phone: 337-419-3586
  • Fax: 855-239-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: