Provider Demographics
NPI:1740375955
Name:KGOADI, BOITUMELO PELOKGALE (RPT)
Entity type:Individual
Prefix:MRS
First Name:BOITUMELO
Middle Name:PELOKGALE
Last Name:KGOADI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CRESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5656
Mailing Address - Country:US
Mailing Address - Phone:337-356-8835
Mailing Address - Fax:337-857-6592
Practice Address - Street 1:3021 VEROT SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8025
Practice Address - Country:US
Practice Address - Phone:337-857-6178
Practice Address - Fax:337-857-6592
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01833F174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist