Healthcare Provider Details

I. General information

NPI: 1063084440
Provider Name (Legal Business Name): JOSE RODRIGO VELASQUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3147 LOMA VISTA RD
VENTURA CA
93003-2917
US

IV. Provider business mailing address

300 HILLMONT AVENUE BLDG 340, SUITE 201
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6298
  • Fax:
Mailing address:
  • Phone: 805-652-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA197763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: