Healthcare Provider Details

I. General information

NPI: 1497822902
Provider Name (Legal Business Name): JUAN MANUEL VELEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA SUITE 101
ORANGE CA
92868
US

IV. Provider business mailing address

805 W LA VETA AVE SUITE 101
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-9595
  • Fax: 714-997-1098
Mailing address:
  • Phone: 714-997-9595
  • Fax: 714-997-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG67887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG67887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: