Provider Demographics
NPI:1598125742
Name:VELES GONZALEZ, ANGELA AVELINA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:AVELINA
Last Name:VELES GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N BURRIS AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-2842
Mailing Address - Country:US
Mailing Address - Phone:323-237-5084
Mailing Address - Fax:
Practice Address - Street 1:5715 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4131
Practice Address - Country:US
Practice Address - Phone:323-237-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2254000000XMedicaid