Healthcare Provider Details

I. General information

NPI: 1104078807
Provider Name (Legal Business Name): DAVID L. VELASCO, JR, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 GEER RD
TURLOCK CA
95382-1146
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-9866
  • Fax: 209-668-9843
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID L VELASCO JR.
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 209-667-4200