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General NPI Number Information
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NPI Number | 1629268396
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Entity Type | Organization
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Legal Business Name | YOUNGSVILLE PEDIATRICS LLC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 814 FORTUNE RD STE 108
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5542
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Country | US
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Telephone | 337-857-5096
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Fax | 337-857-5098
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Provider Business Mailing Address
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Address Line | 814 FORTUNE RD STE 108
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5542
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Country | US
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Telephone | 337-857-5096
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Fax | 337-857-5098
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. SARAH U LAURENTE
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Credential | MD
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Telephone | 337-857-5096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 13797R
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License Number State | LA
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