Individual
DIANNE VELASQUEZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1406 NE 6TH AVE, CAMAS, WA 98607-1339
(360) 834-2996
Mailing address
1406 NE 6TH AVE, CAMAS, WA 98607-1339
(360) 834-2996
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00016548
WA
Other
Enumeration date
05/01/2006
Last updated
07/08/2007
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