Organization
CITYBLOCK MEDICAL PRACTICE LA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVON MINERVE (CORPORATE COUNSEL)
(202) 321-2528
Entity
Organization
Contact information
Practice address
1042 CAMELLIA BLVD, LAFAYETTE, LA 70508-6680
(800) 336-1100
Mailing address
495 FLATBUSH AVE STE C5, BROOKLYN, NY 11225-3706
(800) 336-1100
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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