Healthcare Provider Details

I. General information

NPI: 1053824623
Provider Name (Legal Business Name): ANGEL VELASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2982 BAYONET CT
MARINA CA
93933-4604
US

IV. Provider business mailing address

PO BOX 3222
MONTEREY CA
93942-3222
US

V. Phone/Fax

Practice location:
  • Phone: 831-883-5100
  • Fax:
Mailing address:
  • Phone: 831-883-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: