Healthcare Provider Details

I. General information

NPI: 1992295471
Provider Name (Legal Business Name): ERIKA V VELASCO MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 COPPER AVE NE
ALBUQUERQUE NM
87108-1473
US

IV. Provider business mailing address

3508 ASPEN AVE NE
ALBUQUERQUE NM
87106-1146
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-5557
  • Fax:
Mailing address:
  • Phone: 575-405-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3903
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: