MEDICARE: MISS LUZ I JAQUEZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT044768	TX

General Provider Information

NPI Number	:	1740557321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LUZ I JAQUEZ LMT

Provider Business Mailing Address
First Line	:	3697 BISHOP WAY
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-1623
Country	:	US
Telephone Number	:	915-238-1128
Fax Number	:	866-206-7405

Provider Business Practice Location Address
First Line	:	8201 LOCKHEED DR
Second Line	:	SUITE 115
City	:	EL PASO
State	:	TX
Zip	:	79925-2500
Country	:	US
Telephone Number	:	915-238-1128
Fax Number	:	866-206-7405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2011
Last Update Date	:	11/25/2011

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Directions to “ MISS LUZ I JAQUEZ LMT” Practice Location

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