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General NPI Number Information
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NPI Number | 1851918866
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Entity Type | Organization
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Legal Business Name | LUIS ALFREDO VELAZQUEZ, D.D.S. INC.
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/28/2020
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Provider Practice Location Address
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Address Line | 8977 FOOTHILL BLVD STE F
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3498
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Country | US
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Telephone | 951-446-9318
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Fax |
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Provider Business Mailing Address
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Address Line | 7675 NEWBERRY LN
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City | FONTANA
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State | CA
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Zip | 92336-4249
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Country | US
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Telephone | 951-446-9318
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS ALFREDO VELAZQUEZ
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Credential | D.D.S.
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Telephone | 951-446-9318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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