Organization
LC OF LOUISIANA HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CANDELARIO (SOLE MBR)
(210) 215-0990
Entity
Organization
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES MEMORIAL HEALTH SYSTEM, LAKE CHARLES, LA 70601
(337) 494-3000
Mailing address
1009 MAIN ST, BASTROP, TX 78602-3840
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
03/20/2013
Last updated
03/20/2013
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