Provider Demographics
NPI:1740557321
Name:JAQUEZ, LUZ I (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LUZ
Middle Name:I
Last Name:JAQUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3697 BISHOP WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-1623
Mailing Address - Country:US
Mailing Address - Phone:915-238-1128
Mailing Address - Fax:866-206-7405
Practice Address - Street 1:8201 LOCKHEED DR
Practice Address - Street 2:SUITE 115
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2500
Practice Address - Country:US
Practice Address - Phone:915-238-1128
Practice Address - Fax:866-206-7405
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT044768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist