Provider Demographics
NPI:1073731063
Name:VELASQUEZ, JEFF DELIGERO (DDS)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:DELIGERO
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2830
Mailing Address - Country:US
Mailing Address - Phone:562-424-9473
Mailing Address - Fax:562-989-1006
Practice Address - Street 1:541 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2830
Practice Address - Country:US
Practice Address - Phone:562-424-9473
Practice Address - Fax:562-989-1006
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist