Provider Demographics
NPI:1407889660
Name:VELASCO, ESTRELINO D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTRELINO
Middle Name:D
Last Name:VELASCO
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9382
Mailing Address - Country:US
Mailing Address - Phone:253-922-5262
Mailing Address - Fax:253-922-5299
Practice Address - Street 1:2748 MILTON WAY
Practice Address - Street 2:STE 101
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9382
Practice Address - Country:US
Practice Address - Phone:253-922-5262
Practice Address - Fax:253-922-5299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00040660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301420OtherSTATE L&I
WAG8865158Medicare PIN
WAG17061Medicare UPIN
WAG8900264Medicare PIN
WAGAB26013Medicare PIN
WAG8915071Medicare PIN