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General NPI Number Information
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NPI Number | 1336718089
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Entity Type | Organization
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Legal Business Name | LA B&B ENTERPRISE LLC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 3156 CALGARY ST
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City | MELBOURNE
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State | FL
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Zip | 32935-4639
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Country | US
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Telephone | 321-374-4785
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Fax | 321-732-4942
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Provider Business Mailing Address
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Address Line | 1007 N FEDERAL HWY # 381
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1422
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Country | US
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Telephone | 757-392-9800
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Fax | 888-818-1230
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA A BAKER
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Credential | AUTONOMOUS PROVIDER
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Telephone | 321-374-4785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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