Healthcare Provider Details

I. General information

NPI: 1467173534
Provider Name (Legal Business Name): RUBEN VELAZQUEZ LMFT156397
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST STE 482
SAN FRANCISCO CA
94104-3410
US

IV. Provider business mailing address

584 CASTRO ST # 2634
SAN FRANCISCO CA
94114-2512
US

V. Phone/Fax

Practice location:
  • Phone: 415-894-5342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: