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General NPI Number Information
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NPI Number | 1346863743
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Entity Type | Individual
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Provider Name | RAYNA JENAE WILLIAMS MS, LAT. ATC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 1301 N HWY 123 APT 3404
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City | SAN MARCOS
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State | TX
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Zip | 78666-7843
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Country | US
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Telephone | 562-500-5605
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Fax |
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Provider Business Mailing Address
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Address Line | 165 PACE AVE
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City | HENDERSON
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State | NV
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Zip | 89011-1038
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Country | US
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Telephone | 562-500-5605
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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 | 2000052648
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License Number State | TX
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