Javiera Paz Gonzalez Soto, ME.D, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

320912 Issued in LA

Practice address

4205 Ryan St
Lake Charles, LA 70605-4511

Phone

(865) 279-6536

NPI assigned

Feb 12, 2019

Last updated

Aug 20, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1922564251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 NELSON RD",
            "address_2": "APT. 1423",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70605",
            "telephone_number": "865-279-6536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 RYAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054511",
            "telephone_number": "865-279-6536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ SOTO",
        "first_name": "JAVIERA",
        "middle_name": "PAZ",
        "credential": "ME.D, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-12",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "LA",
            "license": "320912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATHLETIC TRAINER",
            "identifier": "P03669638",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Good Shepherd Home Health Agency, Inc. (Home Health Care 2000 - Lake Charles)
• Arlond Wesley Goodell, PHARMD
• Emily Ann Goodfriend, NP
• Kaylyn Goodfriend
• Trakalyn Goodley, BS

• Athletic Trainer in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Athletic Trainer in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.