Provider Demographics
NPI:1518594191
Name:VELASQUEZ, SARAI (APCC)
Entity Type:Individual
Prefix:
First Name:SARAI
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 N PERRIS BLVD STE N1
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3251
Mailing Address - Country:US
Mailing Address - Phone:951-940-6755
Mailing Address - Fax:
Practice Address - Street 1:2560 N PERRIS BLVD STE N-I
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3254
Practice Address - Country:US
Practice Address - Phone:951-940-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6327101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health