NPI 1174149389

Santiago a Segura Barron, MEDLATATC

Practitioner Athletic Trainer Pocatello, ID

Practice location

Address: Holt Arena 550 Memorial Drive Building 50, Pocatello, ID 83209-0001
Phone: (208) 282-3408
Mailing address: 641 W Bonneville St, Pocatello, ID 83204-3338

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT-751 (ID)

Other Specialist/Technologist providers in Idaho →

Registry record

NPI: 1174149389
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Jun 2020
Record last updated: 23 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.