1790169175 NPI number — LUDIVINA ALEJANDRA VELAZCO GUTIERREZ M.ED.

Table of content: LUDIVINA ALEJANDRA VELAZCO GUTIERREZ M.ED. (NPI 1790169175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790169175 NPI number — LUDIVINA ALEJANDRA VELAZCO GUTIERREZ M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VELAZCO GUTIERREZ
Provider First Name:
LUDIVINA
Provider Middle Name:
ALEJANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790169175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7211 REGENCY SQUARE BLVD
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77036-3138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-780-2833
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7211 REGENCY SQUARE BLVD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-3138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-780-2833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  70301 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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