MEDICARE: JIMENA ALEJANDRA VELAZCO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932679370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMENA ALEJANDRA VELAZCO

Provider Business Mailing Address
First Line	:	5275 MARKET ST STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5275 MARKET ST STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2215
Country	:	US
Telephone Number	:	619-496-7613
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	11/28/2018

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