MEDICARE: BRETO DAIGRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		LA

General Provider Information

NPI Number	:	1568057719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETO DAIGRE

Provider Business Mailing Address
First Line	:	11745 BRICKSOME AVE STE B1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2369
Country	:	US
Telephone Number	:	225-291-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	11745 BRICKSOME AVE STE B1
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2369
Country	:	US
Telephone Number	:	225-291-5492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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Directions to “ BRETO DAIGRE ” Practice Location

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