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General NPI Number Information
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NPI Number | 1073877809
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Entity Type | Individual
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Provider Name | ANNA XOCHILT VELASQUEZ-RODRIQUEZ IMF
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 5340 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9646
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Country | US
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Telephone | 915-206-7081
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Fax |
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Provider Business Mailing Address
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Address Line | 5340 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9646
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Country | US
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Telephone | 915-206-7081
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 109562
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CBT-20240577
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License Number State | NM
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