Basic Information
| Provider Information | |||||||||
| NPI: | 1346863743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | RAYNA | ||||||||
| MiddleName: | JENAE | ||||||||
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| Credential: | ATS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 W BURNETT ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908103222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625005605 | ||||||||
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| Practice Location | |||||||||
| Address1: | NORTH STADIUM DRIVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708030001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255782050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2255A2300X | LA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.