Healthcare Provider Details

I. General information

NPI: 1750218483
Provider Name (Legal Business Name): DORIAN VELAZQUEZ CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 I O O F AVE
GILROY CA
95020-5204
US

IV. Provider business mailing address

290 I O O F AVE
GILROY CA
95020-5204
US

V. Phone/Fax

Practice location:
  • Phone: 408-706-3667
  • Fax:
Mailing address:
  • Phone: 408-846-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: