Individual
LAQUINTA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2875 WASHINGTON BLVD, BEAUMONT, TX 77705-1456
(409) 659-6033
Mailing address
2245 HARRIOT ST, BEAUMONT, TX 77705-1618
(409) 659-6033
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
44790038
TX
Other
Enumeration date
03/10/2023
Last updated
09/11/2025
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