Healthcare Provider Details

I. General information

NPI: 1255871810
Provider Name (Legal Business Name): VALERIA VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RUGBY AVE STE 200
HUNTINGTON PARK CA
90255-6938
US

IV. Provider business mailing address

1501 PALOS VERDES DR N SPC 27
HARBOR CITY CA
90710-4752
US

V. Phone/Fax

Practice location:
  • Phone: 310-321-2826
  • Fax:
Mailing address:
  • Phone: 310-321-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: