Individual
TANQUILA QUENE LASALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 HODGES ST, LAKE CHARLES, LA 70601-7311
(337) 439-5628
Mailing address
2601 HODGES ST, LAKE CHARLES, LA 70601-7311
(337) 439-5628
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
L142600526
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
850700187
—
LA
Enumeration date
05/16/2022
Last updated
05/16/2022
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