Healthcare Provider Details

I. General information

NPI: 1467638056
Provider Name (Legal Business Name): RAFAELA M VELADO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD
PASADENA CA
91107-1448
US

IV. Provider business mailing address

1107 S GLENDORA AVE
WEST COVINA CA
91790-4923
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 626-814-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: