Provider Demographics
NPI:1467781476
Name:FLEUR DE LIS FAMILY CARE
Entity Type:Organization
Organization Name:FLEUR DE LIS FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-546-1021
Mailing Address - Street 1:301 HELIOS AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3756
Mailing Address - Country:US
Mailing Address - Phone:786-546-1021
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:301 HELIOS AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3756
Practice Address - Country:US
Practice Address - Phone:786-546-1021
Practice Address - Fax:504-831-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPPLIED FOROtherPENDING