Healthcare Provider Details

I. General information

NPI: 1487942462
Provider Name (Legal Business Name): GLORIA VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date: 12/03/2025
Reactivation Date: 12/15/2025

III. Provider practice location address

43536 DIVISION ST
LANCASTER CA
93535
US

IV. Provider business mailing address

43536 DIVISION ST
LANCASTER CA
93535
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4783
  • Fax:
Mailing address:
  • Phone: 661-266-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: