Healthcare Provider Details

I. General information

NPI: 1730568304
Provider Name (Legal Business Name): NELSON RAY DRONET JR. B.C.B.A., L.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 RYAN ST # 91895
LAKE CHARLES LA
70605-4511
US

IV. Provider business mailing address

5251 ROCK DR
SULPHUR LA
70665-8292
US

V. Phone/Fax

Practice location:
  • Phone: 337-945-0349
  • Fax:
Mailing address:
  • Phone: 337-562-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: