Provider Demographics
NPI:1003947136
Name:JOSE G VELIZ MD INC
Entity Type:Organization
Organization Name:JOSE G VELIZ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:VELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-489-1876
Mailing Address - Street 1:970 W VALLEY PKWY
Mailing Address - Street 2:STE 401
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2554
Mailing Address - Country:US
Mailing Address - Phone:760-489-1876
Mailing Address - Fax:760-489-1748
Practice Address - Street 1:255 N ELM ST
Practice Address - Street 2:STE 101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3431
Practice Address - Country:US
Practice Address - Phone:760-489-1876
Practice Address - Fax:760-489-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19981OtherPTAN
CA4554810001Medicare NSC
CAW19981OtherPTAN