Organization
PEDIATRIC GROUP OF ACADIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE RABENALDT (CREDENTIALING COORDINATOR)
(337) 330-2576
Entity
Organization
Contact information
Practice address
401 YOUNGSVILLE HWY, SUITE 100, LAFAYETTE, LA 70508-5173
(337) 330-0031
(337) 735-3059
Mailing address
401 YOUNGSVILLE HWY, SUITE 100, LAFAYETTE, LA 70508-5173
(337) 330-0031
(337) 330-0059
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1440604
—
LA
Enumeration date
04/28/2006
Last updated
12/03/2024
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