Provider Demographics
NPI:1992467013
Name:COBIAN, GUADALUPE
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:COBIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BROOKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-9683
Mailing Address - Country:US
Mailing Address - Phone:131-636-4876
Mailing Address - Fax:
Practice Address - Street 1:709 BROOKSIDE PL
Practice Address - Street 2:
Practice Address - City:COLWICH
Practice Address - State:KS
Practice Address - Zip Code:67030-9683
Practice Address - Country:US
Practice Address - Phone:131-636-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician