Provider Demographics
NPI:1497022032
Name:VELARDE, PAT
Entity Type:Individual
Prefix:
First Name:PAT
Middle Name:
Last Name:VELARDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 AIRPORT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2401
Mailing Address - Country:US
Mailing Address - Phone:505-327-0293
Mailing Address - Fax:505-564-4925
Practice Address - Street 1:501 AIRPORT DR STE 260
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2401
Practice Address - Country:US
Practice Address - Phone:505-327-0293
Practice Address - Fax:505-564-4925
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4308101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)