IndividualActive
Athena Castilleja Ezernack, IDMT
NPI 1790014660 · Independent Duty Medical Technicians · Barksdale Afb, LA
Provider details
- NPI number
- 1790014660
- Entity type
- Individual
- Primary specialty
- Independent Duty Medical TechniciansOther Service Providers
- Credential
- IDMT
- Sex
- Female
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
Practice location
407 Barksdale Blvd E
Barksdale Afb, LA 71110-2125
Phone: (318) 456-6165
Approximate (ZIP-level) locationGet directions
Mailing address
407 Barksdale Blvd E
Barksdale Afb, LA 71110-2125
Registry dates
- Enumerated
- 2009-12-23
- Last updated
- 2009-12-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.