Provider Demographics
NPI:1437619228
Name:VELEZ, IAN OLAZO (RN)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:OLAZO
Last Name:VELEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:ATRIANNE NOBERT
Other - Middle Name:OLAZO
Other - Last Name:TRASMONTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:577 MCINTOSH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1534
Mailing Address - Country:US
Mailing Address - Phone:808-381-3604
Mailing Address - Fax:
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95105226163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse