Provider Demographics
NPI:1578060901
Name:VELAZQUEZ AMADOR, ROBERTO ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ALEJANDRO
Last Name:VELAZQUEZ AMADOR
Suffix:
Gender:M
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:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:425 DEL SOL PKWY
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-3442
Practice Address - Country:US
Practice Address - Phone:616-720-4011
Practice Address - Fax:661-720-4012
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL36390200000X
CAA173515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program