LEA BONIFACIO PENALES (NPI# 1003809211) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003809211 |
| Entity Type | Individual |
| Full Name | LEA BONIFACIO PENALES |
| Other Name | LEA A BONIFACIO |
| Credential | MD |
| Practice Address |
2520 Bert Kouns Loop Suite 215 Shreveport LA 71118-3130 |
| Mailing Address |
1202 Louisiana Ave Shreveport LA 71101-3910 |
| Practice Telephone | 3182125970 |
| Practice Fax Number | 3182125975 |
| Mailing Telephone | 3182128946 |
| Mailing Fax Number | 3182124153 |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2015-12-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
203321 | LA | Allopathic & Osteopathic Physicians |
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
40150 | CT | Allopathic & Osteopathic Physicians |
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
MA73968 | NJ | Allopathic & Osteopathic Physicians |
| N | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
4301084897 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1816680 | 05 |
| Street Address |
2520 BERT KOUNS LOOP SUITE 215 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71118-3130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437441698 | Willis-knighton Medical Center, Inc. | Orthopaedic Surgery | 2520 Bert Kouns Loop, Suite 105, Shreveport, LA 71118-3130 | 2011-05-06 |
| 1497047963 | Wk South Orthopedic Clinic | Orthopaedic Surgery | 2520 Bert Kouns Loop, Suite 105, Shreveport, LA 71118-3130 | 2011-05-03 |
| 1003116682 | Kimberly J Bonts | Nurse Practitioner | 2520 Bert Kouns Loop, Suite 215, Shreveport, LA 71118-3130 | 2010-10-28 |
| 1407896285 | Kirk W Cofran Md and Willis-knighton Medical Center | Family Medicine | 2520 Bert Kouns Loop, Suite 102, Shreveport, LA 71118-3130 | 2006-06-08 |
| 1194777441 | Kirk W. Cofran | Family Medicine | 2520 Bert Kouns Loop, Suite 102, Shreveport, LA 71118-3130 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720620784 | Wk Center for Pediatric Gastroenterology | Pediatrics | Wk Center for Pediatric Gastroenterology, 2530 Bert Kouns Industrial Loop, Ste 113, Shreveport, LA 71118 | 2019-10-11 |
| 1306302443 | Diamond Marie Willis | Case Manager/Care Coordinator | 9403 Mansfield Rd., Shreveport, LA 71118 | 2019-02-13 |
| 1194224469 | Latosa Hall | Case Manager/Care Coordinator | 9007 Letha Loop, Shreveport, LA 71118 | 2018-02-01 |
| 1902321623 | Bersheika Lashay Player | Counselor | 9403 Mansfield Road, Shreveport, LA 71118 | 2017-08-03 |
| 1518487149 | Clarke Jackson | Case Manager/Care Coordinator | 9730 Baird Rd Apt 2310, Shreveport, LA 71118 | 2017-06-24 |
| 1770010449 | Darrie'l Smith | Counselor | 2715 Mackey, Shreveport, LA 71118 | 2017-05-12 |
| 1760917041 | Delilah Wells | Case Manager/Care Coordinator | 9005 Walker Rd Apt 722, Shreveport, LA 71118 | 2017-04-25 |
| 1790229664 | We Care Transporttion Services LLC | Secured Medical Transport (VAN) | 2529 Summer Grove Dr, Shreveport, LA 71118 | 2016-12-13 |
| 1063955128 | Commanisha Smith | Social Worker | 2715 Mackey Place, Shreveport, LA 71118 | 2016-11-22 |
| 1023560802 | Yasmin Newman | Counselor | 9812 West Trails End, Shreveport, LA 71118 | 2016-10-27 |
| Find all providers in zip 71118 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194916502 | Sara Sibley Serio | Pediatrics | 4027 Baltimore Ave, Shreveport, LA 71106-1009 | 2007-08-09 |
| 1326062076 | Neonatal Care Specialists, Inc. | Pediatrics | 920 Pierremont Rd, Suite 200, Shreveport, LA 71106-2079 | 2006-07-26 |
| 1780848580 | Wk Ark-la-tex Neonatology | Pediatrics | 2510 Bert Kouns Loop, Room 215, Shreveport, LA 71118-3119 | 2008-07-11 |
| 1720242431 | Scott A Walls | Pediatrics | 2510 Bert Kouns Loop, Room 215, Shreveport, LA 71118-3119 | 2008-07-11 |
| 1972697886 | Shabih Manzar | Pediatrics | 1501 Kings Hwy, Shreveport, LA 71103-4228 | 2006-10-03 |
| 1093735961 | Hassan Mohwad Ibrahim | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Section of Neonatology, Shreveport, LA 71103-4228 | 2006-07-20 |
| 1700806676 | Richard William Krouskop | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Section of Neonatology, Shreveport, LA 71103-4228 | 2006-07-20 |
| 1497772305 | Janet Blount Ashenbrebber | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Section of Neonatology, Shreveport, LA 71103-4228 | 2006-07-16 |
| 1285651190 | Arun Kimar Pramanik | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Section of Neonatology, Shreveport, LA 71103-4228 | 2006-07-16 |
| 1285666487 | Gerald Brent Whitton | Pediatrics | 2510 Bert Kouns Industrial Loop, Room 215, Shreveport, LA 71118-3119 | 2006-07-07 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71118 |
Please comment or provide details below to improve the information on LEA BONIFACIO PENALES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.