Healthcare Provider Details

I. General information

NPI: 1245917244
Provider Name (Legal Business Name): JOSE FERNANDO VELASQUEZ SALDARRIAGA MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

IV. Provider business mailing address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-5055
  • Fax: 949-326-5099
Mailing address:
  • Phone: 949-215-5055
  • Fax: 949-326-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE FERNANDO VELASQUEZ
Title or Position: OWNER CEO
Credential: MD
Phone: 949-215-5055