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General NPI Number Information
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NPI Number | 1407889660
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Entity Type | Individual
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Provider Name | ESTRELINO D VELASCO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 2748 MILTON WAY STE 101
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City | MILTON
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State | WA
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Zip | 98354-9382
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Country | US
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Telephone | 253-922-5262
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Fax | 253-922-5299
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Provider Business Mailing Address
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Address Line | 2748 MILTON WAY STE 101
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City | MILTON
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State | WA
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Zip | 98354-9382
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Country | US
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Telephone | 253-922-5262
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Fax | 253-922-5299
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00040660
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License Number State | WA
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