Healthcare Provider Details

I. General information

NPI: 1922413244
Provider Name (Legal Business Name): THOMAS FRANK VELASQUEZ SR. R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 JOHNSON AVE.
S.L.O CA
93401
US

IV. Provider business mailing address

9305 CARMALITA AVE.
ATASCADERO CA
93422
US

V. Phone/Fax

Practice location:
  • Phone: 805-781-4711
  • Fax:
Mailing address:
  • Phone: 805-466-2762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: