Healthcare Provider Details

I. General information

NPI: 1003726985
Provider Name (Legal Business Name): KOBY GUIDROZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HEYMANN BLVD
LAFAYETTE LA
70503-2322
US

IV. Provider business mailing address

102 ARBOR SPRINGS DR
LAFAYETTE LA
70506-6366
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-4279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: