Healthcare Provider Details

I. General information

NPI: 1932369550
Provider Name (Legal Business Name): BERNARDINO VELASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 16TH ST STE 250
PHOENIX AZ
85020-4478
US

IV. Provider business mailing address

7878 N 16TH ST STE 250
PHOENIX AZ
85020-4478
US

V. Phone/Fax

Practice location:
  • Phone: 602-308-7815
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-308-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number249110
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: