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General NPI Number Information
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NPI Number | 1982211785
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Entity Type | Individual
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Provider Name | WILFREDO ANTONIO VELASCO VARGAS RN
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Gender | Male
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 562-373-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 74 CALLE SANTA CRUZ APT PHG
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City | BAYAMON
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State | PR
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Zip | 00961-7083
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Country | US
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Telephone | 310-906-7434
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 246957
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95042984
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 099694
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA95002659
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License Number State | CA
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