Healthcare Provider Details

I. General information

NPI: 1326112194
Provider Name (Legal Business Name): LEOPOLDO VELASCO JR. N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 CLARA ST
BELL GARDENS CA
90201-4723
US

IV. Provider business mailing address

1919 VUELTA GRANDE AVE
LONG BEACH CA
90815-3655
US

V. Phone/Fax

Practice location:
  • Phone: 562-806-5000
  • Fax:
Mailing address:
  • Phone: 562-221-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number631376
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number211003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: