Healthcare Provider Details

I. General information

NPI: 1619228293
Provider Name (Legal Business Name): MS. VERONICA VELASQUEZ-RODARTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. VERONICA VELASQUEZ-RODARTE

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20702 EL TORO RD APT 57
LAKE FOREST CA
92630-6105
US

IV. Provider business mailing address

20702 EL TORO RD APT 57
LAKE FOREST CA
92630-6105
US

V. Phone/Fax

Practice location:
  • Phone: 562-686-4216
  • Fax:
Mailing address:
  • Phone: 562-686-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT101558
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-101558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: