Healthcare Provider Details

I. General information

NPI: 1053495424
Provider Name (Legal Business Name): VERONICA VELASQUEZ-MORFIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 GOLDEN CENTER DR
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

204 CRADLE MOUNTAIN CT
EL DORADO HILLS CA
95762-6615
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax: 530-621-7707
Mailing address:
  • Phone: 530-676-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA82869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: