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General NPI Number Information
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NPI Number | 1780046672
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Entity Type | Organization
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Legal Business Name | CARMEN VELAZQUEZ MD INC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 2575 EAST EIGHT STREET
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 224-829-2717
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Fax |
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Provider Business Mailing Address
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Address Line | 3507 VALLEY VISTA RD
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City | BONITA
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State | CA
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Zip | 91902-1120
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Country | US
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Telephone | 224-829-2717
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Fax | 619-512-1295
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CARMEN VELAZQUEZ
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Credential | MD INC
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Telephone | 224-829-2717
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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 | A56153
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License Number State | CA
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