Provider Demographics
NPI:1871124859
Name:LAFAYETTE WELLNESS GROUP INC
Entity type:Organization
Organization Name:LAFAYETTE WELLNESS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-806-0293
Mailing Address - Street 1:1042 CAMELLIA BLVD APT 3412
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6692
Mailing Address - Country:US
Mailing Address - Phone:787-202-8247
Mailing Address - Fax:
Practice Address - Street 1:1042 CAMELLIA BLVD APT 3412
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6692
Practice Address - Country:US
Practice Address - Phone:787-951-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service