Provider Demographics
NPI:1316663230
Name:VELASCO RAMIREZ, DAZY MONIQUE (LMT)
Entity type:Individual
Prefix:
First Name:DAZY
Middle Name:MONIQUE
Last Name:VELASCO RAMIREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 NW GLENCOE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-1521
Mailing Address - Country:US
Mailing Address - Phone:971-888-9751
Mailing Address - Fax:
Practice Address - Street 1:2343 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7976
Practice Address - Country:US
Practice Address - Phone:503-868-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist