Healthcare Provider Details

I. General information

NPI: 1750160891
Provider Name (Legal Business Name): LUZ ELVA VASQUEZ CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 JOHN HAYES ST
EL PASO TX
79938-2407
US

IV. Provider business mailing address

3312 TIERRA SARA LN
EL PASO TX
79938-4370
US

V. Phone/Fax

Practice location:
  • Phone: 915-234-2609
  • Fax:
Mailing address:
  • Phone: 915-356-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number88956236995
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1231081274
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: