Provider Demographics
NPI:1073277539
Name:VELASCO MEDICAL CORP
Entity Type:Organization
Organization Name:VELASCO MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:VELASCO ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-242-7696
Mailing Address - Street 1:1741 EASTLAKE PKWY STE 102-540
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2032
Mailing Address - Country:US
Mailing Address - Phone:619-775-8017
Mailing Address - Fax:
Practice Address - Street 1:1741 EASTLAKE PKWY STE 102-540
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2032
Practice Address - Country:US
Practice Address - Phone:619-775-8017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty