Individual
MRS. ATHENA LEE CASTILLEJA EZERNACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDMT
Contact information
Practice address
407 BARKSDALE BLVD E, BARKSDALE AFB, LA 71110-2125
(318) 456-6165
Mailing address
407 BARKSDALE BLVD E, BARKSDALE AFB, LA 71110-2125
(318) 456-6165
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
12/23/2009
Last updated
12/23/2009
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