Provider Demographics
NPI:1235964115
Name:COQUILLAUD-SALOMON, MATHILDE ATHENAIS LEONTINE
Entity type:Individual
Prefix:MS
First Name:MATHILDE
Middle Name:ATHENAIS LEONTINE
Last Name:COQUILLAUD-SALOMON
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 1:15400 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3500
Mailing Address - Country:US
Mailing Address - Phone:936-828-8921
Mailing Address - Fax:
Practice Address - Street 1:15400 LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3500
Practice Address - Country:US
Practice Address - Phone:936-828-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer