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General NPI Number Information
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NPI Number | 1902020019
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Entity Type | Organization
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Legal Business Name | DOC 4 KIDS
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1270 ATTAKAPAS DR STE 401 K
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City | OPELOUSAS
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State | LA
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Zip | 70570-6549
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Country | US
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Telephone | 337-407-0084
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Fax | 337-407-0094
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Provider Business Mailing Address
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Address Line | 1270 ATTAKAPAS DR STE 401 K
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City | OPELOUSAS
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State | LA
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Zip | 70570-6549
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Country | US
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Telephone | 337-407-0084
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Fax | 337-407-0094
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN ENID KOUBICEK
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Credential | M.D.
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Telephone | 337-407-0084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L#13448R
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License Number State | LA
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