MEDICARE: ANA LAURA VELO LEGARRETA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1720673239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA LAURA VELO LEGARRETA

Provider Business Mailing Address
First Line	:	8882 W HOLLYWOOD AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5504
Country	:	US
Telephone Number	:	480-414-7439
Fax Number	:

Provider Business Practice Location Address
First Line	:	6745 N 51ST DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-3425
Country	:	US
Telephone Number	:	623-847-5300
Fax Number	:

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

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	11/29/2021

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Directions to “ ANA LAURA VELO LEGARRETA ” Practice Location

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