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General NPI Number Information
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NPI Number | 1225879588
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Entity Type | Individual
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Provider Name | DERREK CHEVEZ LATHON II
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Gender | Male
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 50 FIELD HOUSE DR.
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City | BATON ROUGE
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State | LA
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Zip | 70802
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Country | US
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Telephone | 225-715-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 50 FILED HOUSE DR.
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City | BATON ROUGE
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State | LA
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Zip | 70802
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 011898409
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License Number State | LA
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