Provider Demographics
NPI:1598789976
Name:TERRAZAS, VICTOR M (LMT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:M
Last Name:TERRAZAS
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 1:2365 TIERRA SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938
Mailing Address - Country:US
Mailing Address - Phone:915-329-7100
Mailing Address - Fax:
Practice Address - Street 1:1280 HAWKINS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-4949
Practice Address - Country:US
Practice Address - Phone:915-329-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT019606225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist