Individual
MS. THALIA CELESTE GUAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2704 17TH ST APT 104, LEWISTON, ID 83501-6395
(208) 286-5366
Mailing address
2704 17TH ST APT 104, LEWISTON, ID 83501-6395
(208) 286-5366
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
ID
Other
Enumeration date
06/05/2022
Last updated
06/05/2022
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