Provider Demographics
NPI:1164768412
Name:VELASCO, SONIA (FNP)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-2432
Mailing Address - Country:US
Mailing Address - Phone:323-588-0084
Mailing Address - Fax:323-588-0336
Practice Address - Street 1:1201 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-2432
Practice Address - Country:US
Practice Address - Phone:323-588-0084
Practice Address - Fax:323-588-0336
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA662159/20455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily