Healthcare Provider Details

I. General information

NPI: 1942127139
Provider Name (Legal Business Name): ULISES VELASCO AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26137 LA PAZ RD STE 230
MISSION VIEJO CA
92691-5337
US

IV. Provider business mailing address

26137 LA PAZ RD STE 230
MISSION VIEJO CA
92691-5337
US

V. Phone/Fax

Practice location:
  • Phone: 949-595-8610
  • Fax: 949-595-0296
Mailing address:
  • Phone: 949-595-8610
  • Fax: 949-595-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: