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NPI Code Detail

MEDICARE: EDUARDO AGUILAR VELASQUEZ LCSW

MEDICARE: EDUARDO AGUILAR VELASQUEZ LCSW
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
11041C0700XClinical Social Worker83303CA
21041C0700XClinical Social Worker106496CA

General Provider Information

NPI Number : 1720540412
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDUARDO AGUILAR VELASQUEZ LCSW
Provider Business Mailing Address
First Line : 301 VICTORIA ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-7131
Country : US
Telephone Number : 949-642-2734
Fax Number :
Provider Business Practice Location Address
First Line : 301 VICTORIA ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-7131
Country : US
Telephone Number : 949-642-2734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2019
Last Update Date : 05/07/2022

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Directions to “ EDUARDO AGUILAR VELASQUEZ LCSW” Practice Location

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