Doctor Name: | EMMANUEL MBANG |
NPI Number: | 1114153095 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 15138 |
Business Practice Address: | 3402 Baker Blvd # A-3 Baker, LA - 707142509 |
Business Phone Number: | 2257747476 |
Business Fax Number: | |
Mailing Address: | 3402 Baker Blvd # A-3, BAKER |
State: | LA |
Postal Code: | 707142509 |
Phone Number: | 2257747476 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2009 |
NPI Last Update Date: | 07/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 253Z00000X |
License Number: | 15138 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | In Home Supportive Care |
Taxonomy Specialization: | |
Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |