MEDICARE: SYNERGY: COMPREHENSIVE CARE FOR MIND, HEART, AND HOME

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235017625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERGY: COMPREHENSIVE CARE FOR MIND, HEART, AND HOME

Provider Business Mailing Address
First Line	:	PO BOX 291083
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-9083
Country	:	US
Telephone Number	:	424-309-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	636 N ST ANDREWS PL APT 1
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1778
Country	:	US
Telephone Number	:	424-309-2641
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF MORAL SUPPORT/FOUNDER
Name	:	CARLOS VELASCO
Credential	:	LPCC
Telephone Number	:	424-309-2641

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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