Healthcare Provider Details

I. General information

NPI: 1932930013
Provider Name (Legal Business Name): JACQUELINE MONCADA VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MEMORIAL DR
CULLOWHEE NC
28723-8911
US

IV. Provider business mailing address

531 ARNOLD RD
LEXINGTON NC
27295-8791
US

V. Phone/Fax

Practice location:
  • Phone: 828-227-7211
  • Fax:
Mailing address:
  • Phone: 336-942-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: