Healthcare Provider Details

I. General information

NPI: 1023749322
Provider Name (Legal Business Name): ESTEFANIA FLORES VELASCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE STE 303
CARMICHAEL CA
95608-6337
US

IV. Provider business mailing address

13412 RANGOON ST
ARLETA CA
91331-6322
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: