Healthcare Provider Details

I. General information

NPI: 1548587744
Provider Name (Legal Business Name): JOSIE VELASCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 W CHILDS AVE
MERCED CA
95341-6805
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-7441
  • Fax: 209-383-1643
Mailing address:
  • Phone: 209-383-7441
  • Fax: 209-383-1643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number607474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: