Provider Demographics
NPI:1104902253
Name:LABEAU, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LABEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4403 MANCHESTER AVE.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92084
Mailing Address - Country:US
Mailing Address - Phone:760-632-9042
Mailing Address - Fax:760-632-0574
Practice Address - Street 1:4403 MANCHESTER AVE.
Practice Address - Street 2:SUITE 107
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-632-9042
Practice Address - Fax:760-632-0574
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD14618Medicare UPIN