Healthcare Provider Details

I. General information

NPI: 1134890411
Provider Name (Legal Business Name): MICHAEL ANTHONY VELASCO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 09/25/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 AIRWAY AVE STE J
COSTA MESA CA
92626-4650
US

IV. Provider business mailing address

3186 AIRWAY AVE STE J
COSTA MESA CA
92626-4650
US

V. Phone/Fax

Practice location:
  • Phone: 949-209-8979
  • Fax:
Mailing address:
  • Phone: 562-658-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC36070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: