Athena Lee Castilleja Ezernack IDMT

NPI 1790014660 - Military Health Care Provider - 1710I1003X

NPI Details
NPI 1790014660
Gender Female
Enumeration Date 12/23/2009
Last Updated 12/23/2009
Entity Type Individual
Active Over 6 years ago
Practice Location
407 BARKSDALE BLVD E
BARKSDALE AFB LA, 71110-2125, US
Phone (318) 456-6165
Fax
Business Location
407 BARKSDALE BLVD E
BARKSDALE AFB LA, 71110-2125, US
Phone (318) 456-6165
Fax
Toxanomy
Taxonomy Code 1710I1003X
License State
License Number
Remove 1790014660 NPI Number
 

According to our database, Mrs. Athena Lee Castilleja Ezernack IDMT NPI is 1790014660, taxonomy code is 1710I1003X Athena Lee Castilleja Ezernack IDMT physically located at 407 Barksdale Blvd E, Barksdale Afb LA, 71110-2125. NPI Number Athena Lee Castilleja Ezernack IDMT has the Individual type.

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1790014660 NPI number is provided on an as is basis without warranty of any kind. 1790014660 is maintained by the National Plan & Provider Enumeration System. The contents of Athena Lee Castilleja Ezernack IDMT are for informational purposes only.