Provider Demographics
NPI:1114357480
Name:VELEZ, ANTONIO (MFTI)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1914
Mailing Address - Country:US
Mailing Address - Phone:323-869-5410
Mailing Address - Fax:323-869-5457
Practice Address - Street 1:502 S NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1914
Practice Address - Country:US
Practice Address - Phone:323-869-5410
Practice Address - Fax:323-869-5457
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist