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General NPI Number Information
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NPI Number | 1275845570
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Entity Type | Individual
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Provider Name | OMAR VELASCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2010
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 100 W CALIFORNIA BLVD
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City | PASADENA
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State | CA
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Zip | 91105-3010
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Country | US
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Telephone | 626-352-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 BARFORD AVE
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-2303
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Country | US
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Telephone | 626-392-1432
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A168081
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 57046
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A168081
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License Number State | CA
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