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General NPI Number Information
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NPI Number | 1609128461
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Entity Type | Individual
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Provider Name | MARIA D VELASQUEZ
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 17326 EDWARDS RD STE A135
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City | CERRITOS
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State | CA
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Zip | 90703-2443
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Country | US
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Telephone | 562-222-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 6618 STAFFORD AVE APT B
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4893
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Country | US
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Telephone | 323-533-2195
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 81415
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License Number State | CA
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