Healthcare Provider Details

I. General information

NPI: 1932823598
Provider Name (Legal Business Name): MISS REBECCA MONIQUE VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S MAIN ST STE 600
ORANGE CA
92868-4514
US

IV. Provider business mailing address

3001 MOUNTAINSIDE DR
CORONA CA
92882-8913
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-2400
  • Fax:
Mailing address:
  • Phone: 714-797-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: