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NPI Code Detail

MEDICARE: LAFAYETTE WEBSTER III

MEDICARE: LAFAYETTE WEBSTER III
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
1171M00000XCase Manager/Care CoordinatorCA

General Provider Information

NPI Number : 1790106847
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAFAYETTE WEBSTER III
Provider Business Mailing Address
First Line : 258 N BLACKSTONE AVE
Second Line :
City : FRESNO
State : CA
Zip : 93701-1913
Country : US
Telephone Number : 559-374-0299
Fax Number : 559-244-0328
Provider Business Practice Location Address
First Line : 258 N BLACKSTONE AVE
Second Line :
City : FRESNO
State : CA
Zip : 93701-1913
Country : US
Telephone Number : 559-274-0299
Fax Number : 559-244-0328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2013
Last Update Date : 12/16/2013

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Directions to “ LAFAYETTE WEBSTER III ” Practice Location

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