MEDICARE: PENELOPE VELASCO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A74761	CA

General Provider Information

NPI Number	:	1023210721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENELOPE VELASCO MD

Provider Business Mailing Address
First Line	:	3660 E IMPERIAL HWY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2653
Country	:	US
Telephone Number	:	310-608-4898
Fax Number	:	310-608-4884

Provider Business Practice Location Address
First Line	:	3660 E IMPERIAL HWY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2653
Country	:	US
Telephone Number	:	310-608-4898
Fax Number	:	310-608-4884

Authorized Official
Title or Position	:	OWNER
Name	:	PENELOPE VELASCO
Credential	:	MD
Telephone Number	:	310-608-4898

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	01/28/2011

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