Provider Demographics
NPI:1528256625
Name:VELASQUEZ, NOHORA ROCIO (LMP)
Entity type:Individual
Prefix:
First Name:NOHORA
Middle Name:ROCIO
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14029 GREENWOOD AVE N APT D
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6821
Mailing Address - Country:US
Mailing Address - Phone:206-334-6422
Mailing Address - Fax:
Practice Address - Street 1:15100 SE 38TH ST STE 305B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1763
Practice Address - Country:US
Practice Address - Phone:425-289-0092
Practice Address - Fax:425-289-0095
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022757225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist