Healthcare Provider Details

I. General information

NPI: 1134979826
Provider Name (Legal Business Name): MICHELLE VELASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

IV. Provider business mailing address

360 S WESTLAKE AVE
LOS ANGELES CA
90057-2906
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9202
  • Fax:
Mailing address:
  • Phone: 213-483-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: