Healthcare Provider Details

I. General information

NPI: 1184251266
Provider Name (Legal Business Name): ADRIAN RECINTO VELASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 BLOOMFIELD AVE
SANTA FE SPRINGS CA
90670-4750
US

IV. Provider business mailing address

234 W FAIRVIEW AVE APT 207
GLENDALE CA
91202-2966
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2830
  • Fax: 562-967-2831
Mailing address:
  • Phone: 914-704-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number036.163059
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036163059
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: