Individual
IVANA GAIL LONGORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1603 SUNSET LN, PALMHURST, TX 78573-8356
(956) 638-0601
Mailing address
1603 SUNSET LN, PALMHURST, TX 78573-8356
(956) 638-0601
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5369
TX
Other
Enumeration date
09/07/2022
Last updated
09/07/2022
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