Individual
LIZBETH VELAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
391 MADISON AVE, OGDEN, UT 84404-2423
(801) 941-0668
Mailing address
391 MADISON AVE, OGDEN, UT 84404-2423
(801) 941-0668
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260022408
RAILROAD MEDICARE
UT
05
—
876000308007
—
UT
Enumeration date
09/02/2009
Last updated
09/02/2009
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