Provider Demographics
NPI:1699902171
Name:FIGUEROA OQUENDO, VENESSA JAELIS (PTA)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:JAELIS
Last Name:FIGUEROA OQUENDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA UNIVERSITARIA CALLE 22 R-10
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-767-6710
Mailing Address - Fax:787-773-6300
Practice Address - Street 1:URB. PEREZ MORRIS CALLE BAEZ # 500
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-6710
Practice Address - Fax:787-773-6300
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1964225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant