Provider Demographics
NPI:1588021216
Name:VELASCO-LOPEZ, GEORGE (RN)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:VELASCO-LOPEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 GREENGLADE AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-1547
Mailing Address - Country:US
Mailing Address - Phone:562-714-5661
Mailing Address - Fax:
Practice Address - Street 1:3663 GREENGLADE AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-1547
Practice Address - Country:US
Practice Address - Phone:562-714-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642753163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse