Provider Demographics
NPI:1972143857
Name:VELEZ, LUZ
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:VELEZ
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 1:436 W AIRDRIE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-3342
Mailing Address - Country:US
Mailing Address - Phone:267-402-0068
Mailing Address - Fax:215-754-0919
Practice Address - Street 1:436 W AIRDRIE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-3342
Practice Address - Country:US
Practice Address - Phone:267-402-0068
Practice Address - Fax:215-754-0919
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA45743601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA45743601OtherSTATE