Healthcare Provider Details

I. General information

NPI: 1891226825
Provider Name (Legal Business Name): PABLO NICHOLAS VELIZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-3040
  • Fax: 831-886-3639
Mailing address:
  • Phone: 831-333-3040
  • Fax: 831-886-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA169558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: