Healthcare Provider Details

I. General information

NPI: 1518690270
Provider Name (Legal Business Name): ROSAMARIA VELAZQUEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23701 E EAST FORK RD
AZUSA CA
91702-1477
US

IV. Provider business mailing address

18835 GALLEANO ST
LA PUENTE CA
91744-6130
US

V. Phone/Fax

Practice location:
  • Phone: 626-910-1202
  • Fax: 888-891-6599
Mailing address:
  • Phone: 626-541-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22-219892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: