Organization
PREVENTION CENTERS OF AMERICA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NITIN MALLA (AGENT)
(337) 446-2928
Entity
Organization
Contact information
Practice address
1830 BERTRAND DR, SUITE 61427, LAFAYETTE, LA 70596-5001
(337) 446-2928
Mailing address
1830 BERTRAND DR, SUITE 61427, LAFAYETTE, LA 70596-5001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/13/2013
Last updated
02/13/2013
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