Provider Demographics
NPI:1568842763
Name:VELAZQUEZ, JUAN A (COMUNITY WORKER)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:A
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:COMUNITY WORKER
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:A
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:172V00000X
Mailing Address - Street 1:100 OCEANGATE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4312
Mailing Address - Country:US
Mailing Address - Phone:562-435-3037
Mailing Address - Fax:
Practice Address - Street 1:100 OCEANGATE
Practice Address - Street 2:STE 550
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4312
Practice Address - Country:US
Practice Address - Phone:310-951-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker