Basic Information
Provider Information | |||||||||
NPI: | 1326077173 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LABEAUD | ||||||||
FirstName: | ANGELLE | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 725 WELCH RD | ||||||||
Address2: |   | ||||||||
City: | PALO ALTO | ||||||||
State: | CA | ||||||||
PostalCode: | 943041601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6504978000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 725 WELCH RD | ||||||||
Address2: |   | ||||||||
City: | PALO ALTO | ||||||||
State: | CA | ||||||||
PostalCode: | 943041601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6504978000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2006 | ||||||||
LastUpdateDate: | 12/09/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0208X | 35-082660 | OH | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | 2080P0208X | A109428 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
ID | Type | State | Issuer | Description | 7233496 | 01 | OH | AETNA | OTHER | 745932 | 01 | OH | BUCKEYE | OTHER | 2502438 | 01 | OH | BCMH | OTHER | 000000301708 | 01 | OH | ANTHEM | OTHER | 000000526039 | 01 | OH | ANTHEM | OTHER | 1011218090001 | 01 | PA | PA MEDICAID | OTHER | 2502438 | 05 | OH |   | MEDICAID | 000000221433 | 01 | OH | UNISON | OTHER | 363730 | 01 | OH | WELLCARE | OTHER | 9200336 | 01 | OH | UNITED HEALTHCARE | OTHER |