Healthcare Provider Details

I. General information

NPI: 1871262386
Provider Name (Legal Business Name): ADRIAN ULYSSES VELAZQUEZ B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 PLAZA SERENA
ONTARIO CA
91764
US

IV. Provider business mailing address

838 PLAZA SERENA
ONTARIO CA
91764
US

V. Phone/Fax

Practice location:
  • Phone: 909-545-1688
  • Fax:
Mailing address:
  • Phone: 909-545-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2837145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: