Healthcare Provider Details

I. General information

NPI: 1265604078
Provider Name (Legal Business Name): JUAN M VELEZ, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE STE 101
ORANGE CA
92868-3928
US

IV. Provider business mailing address

805 W LA VETA AVE STE 101
ORANGE CA
92868-3928
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 TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberG67887
License Number StateCA

VIII. Authorized Official

Name: DR. JUAN MANUEL VELEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 714-997-9595