Provider Demographics
NPI:1548763386
Name:VELASQUEZ, JONATHAN JESSE (LVN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JESSE
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N SHORELINE BLVD STE 700S
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-3718
Mailing Address - Country:US
Mailing Address - Phone:361-937-7887
Mailing Address - Fax:361-937-9421
Practice Address - Street 1:800 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3718
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:361-937-9421
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219774164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse