Provider Demographics
NPI:1801390232
Name:CECCHINI, GARIN
Entity Type:Individual
Prefix:
First Name:GARIN
Middle Name:
Last Name:CECCHINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 WILLOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3143
Mailing Address - Country:US
Mailing Address - Phone:337-513-7303
Mailing Address - Fax:
Practice Address - Street 1:5819 WILLOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-3143
Practice Address - Country:US
Practice Address - Phone:337-513-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies