Provider Demographics
NPI:1144003385
Name:VELAZQUEZ, EDUARDO II
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:VELAZQUEZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N EMILY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1909
Mailing Address - Country:US
Mailing Address - Phone:714-782-8627
Mailing Address - Fax:
Practice Address - Street 1:908 N EMILY ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1909
Practice Address - Country:US
Practice Address - Phone:714-782-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker