Healthcare Provider Details

I. General information

NPI: 1801176565
Provider Name (Legal Business Name): JEFFREY B VELASCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31422 KAILUA DR
WINCHESTER CA
92596-8511
US

IV. Provider business mailing address

31422 KAILUA DR
WINCHESTER CA
92596-8511
US

V. Phone/Fax

Practice location:
  • Phone: 626-877-3019
  • Fax:
Mailing address:
  • Phone: 626-877-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95263229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number255359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: