Provider Demographics
NPI:1275084360
Name:VELASQUEZ, EMIL M (LAC)
Entity Type:Individual
Prefix:MR
First Name:EMIL
Middle Name:M
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2224
Mailing Address - Country:US
Mailing Address - Phone:510-866-2734
Mailing Address - Fax:
Practice Address - Street 1:3022 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2224
Practice Address - Country:US
Practice Address - Phone:510-866-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist