Organization
BUABENG FAMILY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWAME BAUBENG MD (OWNER)
(757) 373-3551
Entity
Organization
Contact information
Practice address
7423 PICARDY AVE STE D, BATON ROUGE, LA 70808-4362
(225) 228-2564
Mailing address
7423 PICARDY AVE STE D, BATON ROUGE, LA 70808-4362
(225) 228-2564
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
305542
MEDICAL BOARD
LA
Enumeration date
09/16/2021
Last updated
09/16/2021
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