Provider Demographics
NPI:1699268060
Name:VELASQUEZ LEBRON, LOIDA
Entity type:Individual
Prefix:
First Name:LOIDA
Middle Name:
Last Name:VELASQUEZ LEBRON
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 1:18 MORSE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-7035
Mailing Address - Country:US
Mailing Address - Phone:401-241-5292
Mailing Address - Fax:
Practice Address - Street 1:719 FRONT ST UNIT 107
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-5278
Practice Address - Country:US
Practice Address - Phone:401-769-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist