Provider Demographics
NPI:1396225157
Name:VELASCO, CRUZ ANGELINA (RN)
Entity Type:Individual
Prefix:MISS
First Name:CRUZ
Middle Name:ANGELINA
Last Name:VELASCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E GONZALES RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3707
Mailing Address - Country:US
Mailing Address - Phone:805-658-4471
Mailing Address - Fax:805-650-1521
Practice Address - Street 1:2220 E GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3707
Practice Address - Country:US
Practice Address - Phone:805-658-4471
Practice Address - Fax:805-650-1521
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95071565171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator