# IMMUNOLASE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427416171
- **Authorized official:** BRENNEN LARK (MEMBER/CEO)
- **Authorized official phone:** (504) 372-6250

## Contact information

- **Practice address:** 1901 MANHATTAN BLVD BLDG D, HARVEY, LA 70058-3583
- **Practice address phone:** (504) 372-6250
- **Mailing address:** PO BOX 1414, SAGAMORE BEACH, MA 02562-1414
- **Mailing address phone:** (504) 372-6250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KI0005X | Clinical & Laboratory Immunology (Allergy & Immunology) Physician | 19D2105974 | LA | Yes |

## Other

- **Enumeration date:** 02/09/2016
- **Last updated:** 03/23/2018