Healthcare Provider Details

I. General information

NPI: 1891252409
Provider Name (Legal Business Name): MARIA VELAZQUEZ B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FRTH PLN BLVD
VANCOUVER WA
98661-7254
US

IV. Provider business mailing address

6926 NE FRTH PLN BLVD
VANCOUVER WA
98661-7254
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3000
  • Fax:
Mailing address:
  • Phone: 360-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: