Provider Demographics
NPI:1093837783
Name:VOLTAIRE S. VELARDE MD INC
Entity Type:Organization
Organization Name:VOLTAIRE S. VELARDE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VOLTAIRE
Authorized Official - Middle Name:SALANGA
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-552-7111
Mailing Address - Street 1:646 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4433
Mailing Address - Country:US
Mailing Address - Phone:707-552-7111
Mailing Address - Fax:
Practice Address - Street 1:646 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4433
Practice Address - Country:US
Practice Address - Phone:707-552-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A495690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ21815ZMedicare ID - Type Unspecified