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General NPI Number Information
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NPI Number | 1023983574
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Entity Type | Individual
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Provider Name | KRYSTAL AMANDA VELASCO PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 8300 UTICA AVE STE 259
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3852
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Country | US
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Telephone | 909-906-1505
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Fax | 909-906-1508
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Provider Business Mailing Address
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Address Line | 1713 CASEROS DR
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City | SAN JACINTO
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State | CA
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Zip | 92582-3305
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Country | US
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Telephone | 909-781-9524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95037330
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License Number State | CA
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