MEDICARE: LUZ MARY CATALINA VELASCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	308632	NY

General Provider Information

NPI Number	:	1720340789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ MARY CATALINA VELASCO

Provider Business Mailing Address
First Line	:	8707 35TH AVE
Second Line	:	APT 4F
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5643
Country	:	US
Telephone Number	:	347-615-3822
Fax Number	:

Provider Business Practice Location Address
First Line	:	8707 35TH AVE
Second Line	:	APT 4F
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5643
Country	:	US
Telephone Number	:	347-615-3822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	04/18/2016

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Directions to “ LUZ MARY CATALINA VELASCO ” Practice Location

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