Provider Demographics
NPI:1992494694
Name:THERIOT, LAUREN RODRIGUEZ
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RODRIGUEZ
Last Name:THERIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 VILLERE DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2507
Mailing Address - Country:US
Mailing Address - Phone:985-855-0875
Mailing Address - Fax:
Practice Address - Street 1:135 VILLERE DR
Practice Address - Street 2:
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-2507
Practice Address - Country:US
Practice Address - Phone:985-855-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program