Provider Demographics
NPI:1457658338
Name:VELASQUEZ, MAGALY M (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:M
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9426 TWIN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7932
Mailing Address - Country:US
Mailing Address - Phone:909-466-4999
Mailing Address - Fax:909-466-9444
Practice Address - Street 1:9426 TWIN OAKS PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7932
Practice Address - Country:US
Practice Address - Phone:909-466-4999
Practice Address - Fax:909-466-9444
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist