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General NPI Number Information
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NPI Number | 1881336964
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Entity Type | Individual
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Provider Name | VIVIAN VELASQUEZ MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 950 W D ST
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City | ONTARIO
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State | CA
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Zip | 91762-3026
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Country | US
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Telephone | 909-459-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 15829 ELLINGTON WAY
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City | CHINO HILLS
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State | CA
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Zip | 91709-7963
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Country | US
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Telephone | 626-235-5683
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP28562
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License Number State | CA
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