Provider Demographics
NPI:1093827339
Name:VELASCO, FRANK ELIAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ELIAS
Last Name:VELASCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7967
Mailing Address - Country:US
Mailing Address - Phone:310-574-1748
Mailing Address - Fax:310-821-5602
Practice Address - Street 1:8055 W MANCHESTER AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7967
Practice Address - Country:US
Practice Address - Phone:310-574-1748
Practice Address - Fax:310-821-5602
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11891103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical