Provider Demographics
NPI:1437281888
Name:VELAZQUEZ, NAOMI (HS)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PENNSYLVANIA AVE # B
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-9103
Mailing Address - Country:US
Mailing Address - Phone:707-769-9818
Mailing Address - Fax:
Practice Address - Street 1:411 PENNSYLVANIA AVE # B
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-9103
Practice Address - Country:US
Practice Address - Phone:707-769-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman