Search › California › 104100000X
Bienville South
NPI 1780188573 · on the registry since 2018
Practice
- Address
- 3660 W Slauson Ave
Los Angeles, CA 90043 - Phone
- (323) 214-9166
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Also registered as
- 101Y00000X
101YM0800X
103TA0400X
101YP1600X
103K00000X
103TF0000X
103TM1800X
104100000X
171000000X
171M00000X
172A00000X
174N00000X
221700000X - Licence states on file
- CA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-03-19
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California