Provider Demographics
NPI:1497880546
Name:VELOSO, MARILOU D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILOU
Middle Name:D
Last Name:VELOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 STOCKDALE HWY #150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-663-7500
Mailing Address - Fax:661-663-3063
Practice Address - Street 1:9508 STOCKDALE HWY #150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-663-7500
Practice Address - Fax:661-663-3063
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88298207Q00000X, 208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A882980Medicaid
CA00A882980Medicaid