Provider Demographics
NPI:1528830692
Name:MOCKFORD, VEDA LEONOR (LMT)
Entity type:Individual
Prefix:MS
First Name:VEDA
Middle Name:LEONOR
Last Name:MOCKFORD
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 1:271 CALLE ELEONOR ROOSEVELT
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2818
Mailing Address - Country:US
Mailing Address - Phone:787-550-6169
Mailing Address - Fax:
Practice Address - Street 1:271 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2818
Practice Address - Country:US
Practice Address - Phone:787-550-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist