Provider Demographics
NPI:1053537613
Name:ROBICHAUX, SIMONE (SFA)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:ROBICHAUX
Suffix:
Gender:F
Credentials:SFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11187 HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:LA
Mailing Address - Zip Code:70374-3930
Mailing Address - Country:US
Mailing Address - Phone:985-693-6602
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:11187 HIGHWAY 308
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:LA
Practice Address - Zip Code:70374-3930
Practice Address - Country:US
Practice Address - Phone:985-693-6602
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist