Provider Demographics
NPI:1801515721
Name:ARANGA, RONTAVIA TYRESS
Entity type:Individual
Prefix:
First Name:RONTAVIA
Middle Name:TYRESS
Last Name:ARANGA
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 1:1 NORTH STADIUM DR
Mailing Address - Street 2:BROUSSARD CENTER FOR ATHLETIC TRAINING
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803
Mailing Address - Country:US
Mailing Address - Phone:225-578-0681
Mailing Address - Fax:225-578-3924
Practice Address - Street 1:1 NORTH STADIUM DR
Practice Address - Street 2:BROUSSARD CENTER FOR ATHLETIC TRAINING
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803
Practice Address - Country:US
Practice Address - Phone:225-578-0681
Practice Address - Fax:225-578-3924
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program