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General NPI Number Information
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NPI Number | 1942539044
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Entity Type | Organization
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Legal Business Name | LAFAYETTE DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 12/18/2009
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 1019 KALISTE SALOOM RD SUITE # 711
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City | LAFAYETTE
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State | LA
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Zip | 70508-4935
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Country | US
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Telephone | 337-214-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 12550 WHITTINGTON DR SUITE # 804
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City | HOUSTON
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State | TX
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Zip | 77077-4800
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Country | US
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Telephone | 337-214-4199
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YERBOL KOSHIMBAYEV
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Credential |
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Telephone | 985-381-6758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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