Provider Demographics
NPI:1194382093
Name:DELAPAZ, JOSE ANGEL (LMT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:DELAPAZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 NE 43RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 E EVERGREEN BLVD STE 322A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3385
Practice Address - Country:US
Practice Address - Phone:360-953-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-26
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60951913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist