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General NPI Number Information
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NPI Number | 1396342937
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Entity Type | Individual
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Provider Name | DENISE VELAZQUEZ
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Gender | Female
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 780 E GILBERT ST BLDG H
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-5085
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Country | US
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Telephone | 909-763-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 1970 7TH ST APT 115
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City | RIVERSIDE
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State | CA
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Zip | 92507-4391
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Country | US
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Telephone | 323-831-4867
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | Y3758975
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17881
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License Number State | CA
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