Provider Demographics
NPI:1043687684
Name:VELASCO-SCOTT, SANDRA (PSYD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:VELASCO-SCOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:VELASCO-SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:487 ALAMO CREEK CT APT C
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4264
Mailing Address - Country:US
Mailing Address - Phone:408-508-0084
Mailing Address - Fax:
Practice Address - Street 1:1600 CALIFORNIA DR
Practice Address - Street 2:VACAVILLE
Practice Address - City:CA
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-446-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30939103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical