Provider Demographics
NPI:1356439673
Name:VELASCO, LOIS HERNANDEZ (DDS)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:HERNANDEZ
Last Name:VELASCO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 W 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4614
Mailing Address - Country:US
Mailing Address - Phone:310-547-9428
Mailing Address - Fax:
Practice Address - Street 1:1441 W 8TH STREET
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3803
Practice Address - Country:US
Practice Address - Phone:310-832-5295
Practice Address - Fax:310-832-8460
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice