Provider Demographics
NPI:1518690270
Name:VELAZQUEZ, ROSAMARIA (RBT)
Entity Type:Individual
Prefix:
First Name:ROSAMARIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18835 GALLEANO ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-6130
Mailing Address - Country:US
Mailing Address - Phone:626-541-7058
Mailing Address - Fax:
Practice Address - Street 1:2671 SATURN STREET SUITE J
Practice Address - Street 2:SUITE J
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6507
Practice Address - Country:US
Practice Address - Phone:562-889-4256
Practice Address - Fax:888-891-6599
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22-219892106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician