Most Relevant Information
Provider Data
| NPI Number: | 1003809211 |
| Provider Name: | LEA BONIFACIO PENALES MD |
| Entity Type: | Individual |
| Taxonomy Code: | 2080N0001X |
| Specialty: | Pediatrics |
| License Number: | 4301084897 |
Most Important Dates
| Enumeration Date: | 08/24/2005 |
| Last Updated: | 12/07/2015 |
Provider Practice Location
2520 BERT KOUNS LOOP
SUITE 215
SHREVEPORT
LA
711183130
Practice Location Phone/Fax
| Phone: | 3182125970 |
| Fax: | 3182125975 |
Provider Mailing Location
1202 LOUISIANA AVE
SHREVEPORT
LA
711013910
Provider Mailing Phone/Fax
| Phone: | 3182128946 |
| Fax: | 3182124153 |