Healthcare Provider Details

I. General information

NPI: 1881212389
Provider Name (Legal Business Name): AYLIN MAYAN VELASCO ACUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E SEQUOIA AVE
TULARE CA
93274-4508
US

IV. Provider business mailing address

276 PRESIDIO AVE
PORTERVILLE CA
93257-5474
US

V. Phone/Fax

Practice location:
  • Phone: 559-556-0030
  • Fax:
Mailing address:
  • Phone: 559-544-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: