Provider Demographics
NPI:1780329474
Name:CHAVEZ VELASQUEZ, ANA LIZ (MD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LIZ
Last Name:CHAVEZ VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HOSPITAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BEDOFRD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-848-2993
Mailing Address - Fax:
Practice Address - Street 1:1600 HOSPITAL PARKWAY
Practice Address - Street 2:
Practice Address - City:BEDOFRD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-848-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2023-02-15
Deactivation Date:2023-02-08
Deactivation Code:
Reactivation Date:2023-02-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program