Provider Demographics
NPI:1609464114
Name:VELASQUEZ ROSALES, NORMITA RAQUEL (PT41847)
Entity Type:Individual
Prefix:
First Name:NORMITA
Middle Name:RAQUEL
Last Name:VELASQUEZ ROSALES
Suffix:
Gender:F
Credentials:PT41847
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Mailing Address - Street 1:6119 DANNY DR UNIT 16
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-5324
Mailing Address - Country:US
Mailing Address - Phone:408-207-3025
Mailing Address - Fax:
Practice Address - Street 1:1947 N CALIFORNIA ST STE BANDC
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6029
Practice Address - Country:US
Practice Address - Phone:209-463-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT41847167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician