MEDICARE: JOSE ROBERTO VELASQUEZ CASE MANAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator		NM

General Provider Information

NPI Number	:	1912941436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ROBERTO VELASQUEZ CASE MANAGER

Provider Business Mailing Address
First Line	:	385 CALLE DE ALEGRA STE A
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3423
Country	:	US
Telephone Number	:	575-526-1105
Fax Number	:	575-524-4266

Provider Business Practice Location Address
First Line	:	826 ANTHONY DR
Second Line	:
City	:	ANTHONY
State	:	NM
Zip	:	88021
Country	:	US
Telephone Number	:	575-201-5135
Fax Number	:	575-449-4052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/04/2019

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