Provider Demographics
NPI:1750160891
Name:VASQUEZ, LUZ ELVA (CPT)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:ELVA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 TIERRA SARA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4370
Mailing Address - Country:US
Mailing Address - Phone:915-356-0440
Mailing Address - Fax:
Practice Address - Street 1:2720 JOHN HAYES ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2407
Practice Address - Country:US
Practice Address - Phone:915-234-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX889562369952081S0010X
TX1231081274171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine