Healthcare Provider Details

I. General information

NPI: 1518882083
Provider Name (Legal Business Name): AELLEN VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AELLEN VELAZQUEZ

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 KATELLA AVE
LOS ALAMITOS CA
90720-3511
US

IV. Provider business mailing address

4220 KATELLA AVE
LOS ALAMITOS CA
90720-3511
US

V. Phone/Fax

Practice location:
  • Phone: 562-342-9994
  • Fax:
Mailing address:
  • Phone: 562-342-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: