| Cityblock Medical Practice La, Llc | |
|
1042 Camellia Blvd Lafayette LA 70508-6680 | |
| (800) 336-1100 | |
| Not Available |
| Full Name | Cityblock Medical Practice La, Llc |
|---|---|
| Speciality | General Practice |
| Location | 1042 Camellia Blvd, Lafayette, Louisiana |
| Authorized Official Name and Position | Devon Minerve (CORPORATE COUNSEL) |
| Authorized Official Contact | 2023212528 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cityblock Medical Practice La, Llc 495 Flatbush Ave Ste C5 Brooklyn NY 11225-3706 Ph: (800) 336-1100 | Cityblock Medical Practice La, Llc 1042 Camellia Blvd Lafayette LA 70508-6680 Ph: (800) 336-1100 |
| NPI Number | 1790447373 |
|---|---|
| Provider Enumeration Date | 10/11/2021 |
| Last Update Date | 10/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790447373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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