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Individual
TRAVIS DEAN LAQUA
Active
Individual
TRAVIS DEAN LAQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
717765
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213549313
—
TX
01
—
8497UQ
BCBS
TX
Enumeration date
04/29/2010
Last updated
01/20/2023
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