Healthcare Provider Details

I. General information

NPI: 1639202690
Provider Name (Legal Business Name): ERLINDA C. VELASCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N ALVARADO ST STE 106
LOS ANGELES CA
90026-4016
US

IV. Provider business mailing address

2316 BRANDEN ST
LOS ANGELES CA
90026-1479
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-3324
  • Fax: 213-413-6017
Mailing address:
  • Phone: 323-664-8827
  • Fax: 323-644-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA367870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: