Provider Demographics
NPI:1205405164
Name:VELASCO, JAQUELINE UMIPIG
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:UMIPIG
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 HUCKBURN AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8561
Mailing Address - Country:US
Mailing Address - Phone:626-380-7672
Mailing Address - Fax:
Practice Address - Street 1:1017 HUCKBURN AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8561
Practice Address - Country:US
Practice Address - Phone:626-380-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant