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Individual

BETTY GOBERT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1506 SUMMIT ST, LAKE CHARLES, LA 70615-4977
(337) 309-5692
(337) 855-1829
Mailing address
1506 SUMMIT ST, LAKE CHARLES, LA 70615-4977
(337) 309-5692
(337) 855-1829

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1029530
LA
Enumeration date
06/17/2013
Last updated
06/17/2013
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