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General NPI Number Information
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NPI Number | 1396076071
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Entity Type | Individual
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Provider Name | LENA BRETOUS MD MPH
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 4104 PERCIVAL RD
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City | COLUMBIA
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State | SC
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Zip | 29229-8307
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Country | US
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Telephone | 800-327-3183
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Fax | 800-610-5685
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Provider Business Mailing Address
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Address Line | 4101 PERCIVAL RD
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City | COLUMBIA
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State | SC
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Zip | 29229-8320
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Country | US
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Telephone | 800-327-3183
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Fax | 800-610-5685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 23701
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License Number State | SC
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