Provider Demographics
NPI:1588398028
Name:HODGES, LUZVIMINDA A
Entity type:Individual
Prefix:MS
First Name:LUZVIMINDA
Middle Name:A
Last Name:HODGES
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 1:13103 BANNING ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-0503
Mailing Address - Country:US
Mailing Address - Phone:760-514-2733
Mailing Address - Fax:
Practice Address - Street 1:13103 BANNING ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-0503
Practice Address - Country:US
Practice Address - Phone:760-514-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36224225700000X
CABSLH-001325-2021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist