Provider Demographics
NPI:1720673239
Name:VELO LEGARRETA, ANA LAURA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:VELO LEGARRETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8882 W HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5504
Mailing Address - Country:US
Mailing Address - Phone:480-414-7439
Mailing Address - Fax:
Practice Address - Street 1:6745 N 51ST DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3425
Practice Address - Country:US
Practice Address - Phone:623-847-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant