Provider Demographics
NPI:1821216144
Name:LADEBE LLC
Entity Type:Organization
Organization Name:LADEBE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELTORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-288-5557
Mailing Address - Street 1:PO BOX 81736
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1736
Mailing Address - Country:US
Mailing Address - Phone:337-291-2455
Mailing Address - Fax:
Practice Address - Street 1:804 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6661
Practice Address - Country:US
Practice Address - Phone:337-291-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444855Medicaid
LA1444855Medicaid