Provider Demographics
NPI:1336718089
Name:LA B&B ENTERPRISE LLC
Entity Type:Organization
Organization Name:LA B&B ENTERPRISE LLC
Other - Org Name:PITCHER PRIMARY CARE AND LA WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUTONOMOUS PROVIDER
Authorized Official - Phone:321-374-4785
Mailing Address - Street 1:2511 N HIATUS RD # 168
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1301
Mailing Address - Country:US
Mailing Address - Phone:321-374-4785
Mailing Address - Fax:321-732-4942
Practice Address - Street 1:3156 CALGARY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4639
Practice Address - Country:US
Practice Address - Phone:321-374-4785
Practice Address - Fax:321-732-4942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty