Healthcare Provider Details

I. General information

NPI: 1124189576
Provider Name (Legal Business Name): PENELOPE VELASCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8077 FLORENCE AVE STE 112
DOWNEY CA
90240-3894
US

IV. Provider business mailing address

9502 HORLEY AVENUE
DOWNEY CA
90240
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-6031
  • Fax:
Mailing address:
  • Phone: 562-927-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA74761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: