Provider Demographics
NPI:1922286772
Name:VECINAL, CORAZON (LMT)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:
Last Name:VECINAL
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 1:10937 COUNTY ROAD 67
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-5233
Mailing Address - Country:US
Mailing Address - Phone:832-227-5647
Mailing Address - Fax:713-333-5024
Practice Address - Street 1:10937 COUNTY ROAD 67
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-5233
Practice Address - Country:US
Practice Address - Phone:832-227-5647
Practice Address - Fax:713-333-5024
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist