Individual
JAVIERA PAZ GONZALEZ SOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ME.D, LAT, ATC
Contact information
Practice address
4205 RYAN ST, LAKE CHARLES, LA 70605-4511
(865) 279-6536
Mailing address
4605 NELSON RD, APT. 1423, LAKE CHARLES, LA 70605
(865) 279-6536
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
320912
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P03669638
ATHLETIC TRAINER
—
Enumeration date
02/12/2019
Last updated
08/20/2021
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