Healthcare Provider Details

I. General information

NPI: 1821227422
Provider Name (Legal Business Name): JOVANNA M VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BROADWAY SUITE 88
KING CITY CA
93930
US

IV. Provider business mailing address

200 BROADWAY ST SUITE 88
KING CITY CA
93930-2865
US

V. Phone/Fax

Practice location:
  • Phone: 831-386-6868
  • Fax: 831-386-6877
Mailing address:
  • Phone: 831-386-6868
  • Fax: 831-386-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: