Healthcare Provider Details

I. General information

NPI: 1992533152
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL VELEZ II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 SUMMER TREE CT
SIMI VALLEY CA
93065-5045
US

IV. Provider business mailing address

691 SUMMER TREE CT
SIMI VALLEY CA
93065-5045
US

V. Phone/Fax

Practice location:
  • Phone: 909-631-3111
  • Fax:
Mailing address:
  • Phone: 909-631-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: