Healthcare Provider Details

I. General information

NPI: 1275845570
Provider Name (Legal Business Name): OMAR VELASCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

1206 BARFORD AVE
HACIENDA HEIGHTS CA
91745-2303
US

V. Phone/Fax

Practice location:
  • Phone: 626-352-1444
  • Fax:
Mailing address:
  • Phone: 626-392-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA168081
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57046
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA168081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: