Provider Demographics
NPI:1629671227
Name:VELASQUEZ, SUYAPA VASSBERG (RDH)
Entity Type:Individual
Prefix:
First Name:SUYAPA
Middle Name:VASSBERG
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 KINGSPOINT DR APT 68
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6507
Mailing Address - Country:US
Mailing Address - Phone:512-638-6858
Mailing Address - Fax:
Practice Address - Street 1:6901 HELEN OF TROY STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-3049
Practice Address - Country:US
Practice Address - Phone:915-493-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23956124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist