Healthcare Provider Details

I. General information

NPI: 1467258871
Provider Name (Legal Business Name): VIZZABOL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 04/03/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLECO DRIVE APT 204
PINEVILLE LA
71360
US

IV. Provider business mailing address

4245 N CENTRAL EXPY STE 490
DALLAS TX
75205-4231
US

V. Phone/Fax

Practice location:
  • Phone: 318-664-9307
  • Fax:
Mailing address:
  • Phone: 318-664-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DEVREK GUIDRY
Title or Position: OWNER
Credential:
Phone: 318-664-9307