Healthcare Provider Details

I. General information

NPI: 1396076071
Provider Name (Legal Business Name): LENA BRETOUS MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 PERCIVAL RD
COLUMBIA SC
29229-8307
US

IV. Provider business mailing address

4101 PERCIVAL RD
COLUMBIA SC
29229-8320
US

V. Phone/Fax

Practice location:
  • Phone: 800-327-3183
  • Fax: 800-610-5685
Mailing address:
  • Phone: 800-327-3183
  • Fax: 800-610-5685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number23701
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: