Healthcare Provider Details

I. General information

NPI: 1669782595
Provider Name (Legal Business Name): JOEL Q VELASQUEZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12677 HESPERIA RD STE 130
VICTORVILLE CA
92395-7735
US

IV. Provider business mailing address

12677 HESPERIA RD STE 130
VICTORVILLE CA
92395-7735
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-7763
  • Fax: 760-241-6383
Mailing address:
  • Phone: 760-241-7763
  • Fax: 760-241-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PENNY ELLEN LUGO
Title or Position: OFFICE MANAGER
Credential:
Phone: 760-490-9982