Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 07802 | LA |
NPI | 1053627950 |
---|---|
Provider Name | Delaina Darby Guthrie |
First Address | Lake Charles, LA 70601-8780 |
Second Address | Lake Charles, LA 70601-8780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 30/08/2010 |