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NPI Code Detail

MEDICARE: MR. LEOPOLDO VELASCO JR. N.P.

MEDICARE: MR. LEOPOLDO VELASCO JR. N.P.
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
1163WP0808XPsychiatric/Mental Health Registered Nurse631376CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner211003CA

General Provider Information

NPI Number : 1326112194
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEOPOLDO VELASCO JR. N.P.
Provider Business Mailing Address
First Line : 1919 VUELTA GRANDE AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-3655
Country : US
Telephone Number : 562-221-8205
Fax Number :
Provider Business Practice Location Address
First Line : 6001 CLARA ST
Second Line :
City : BELL GARDENS
State : CA
Zip : 90201-4723
Country : US
Telephone Number : 562-806-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 01/26/2017

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