Provider Demographics
NPI:1932821311
Name:VELAZQUEZ, LUDIVINA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LUDIVINA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 LOS GATOS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5523
Mailing Address - Country:US
Mailing Address - Phone:408-402-3076
Mailing Address - Fax:
Practice Address - Street 1:455 LOS GATOS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5523
Practice Address - Country:US
Practice Address - Phone:408-402-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist