Provider Demographics
NPI:1326077173
Name:LABEAUD, ANGELLE DESIREE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELLE
Middle Name:DESIREE
Last Name:LABEAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8000
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109428208000000X, 2080P0208X
OH35-0826602080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9200336OtherUNITED HEALTHCARE
OH000000301708OtherANTHEM
OH363730OtherWELLCARE
OH000000526039OtherANTHEM
OH7233496OtherAETNA
OH745932OtherBUCKEYE
OH000000221433OtherUNISON
PA1011218090001OtherPA MEDICAID
OH2502438Medicaid
OH2502438OtherBCMH
OH000000301708OtherANTHEM
OH2502438OtherBCMH
OHH96294Medicare UPIN