Provider Demographics
NPI:1063268290
Name:TASCON, DORA (LMT)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:TASCON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DORA
Other - Middle Name:
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7205 LAKE MELODY DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4417
Mailing Address - Country:US
Mailing Address - Phone:361-779-7086
Mailing Address - Fax:
Practice Address - Street 1:7205 LAKE MELODY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4417
Practice Address - Country:US
Practice Address - Phone:361-779-7086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT034568225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist