# CITYBLOCK MEDICAL PRACTICE LA, LLC

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

## Provider details

- **NPI number:** 1790447373
- **Authorized official:** DEVON MINERVE (CORPORATE COUNSEL)
- **Authorized official phone:** (202) 321-2528

## Contact information

- **Practice address:** 1042 CAMELLIA BLVD, LAFAYETTE, LA 70508-6680
- **Practice address phone:** (800) 336-1100
- **Mailing address:** 495 FLATBUSH AVE STE C5, BROOKLYN, NY 11225-3706
- **Mailing address phone:** (800) 336-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2021
- **Last updated:** 10/11/2021