MEDICARE: RUTH VELASQUEZ FNP-BC

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	207Q00000X	Family Medicine Physician	24196320	VA

General Provider Information

NPI Number	:	1053266106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH VELASQUEZ FNP-BC

Provider Business Mailing Address
First Line	:	4981 LANDOVER CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7617 LITTLE RIVER TPKE STE 850
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2673
Country	:	US
Telephone Number	:	571-665-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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