Provider Demographics
NPI:1639175490
Name:VELASQUEZ, JOEL QUIJANO (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:QUIJANO
Last Name:VELASQUEZ
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 1:12677 HESPERIA RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:760-241-7763
Mailing Address - Fax:
Practice Address - Street 1:12677 HESPERIA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:760-241-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA051953OtherLICENSE
CAA051953OtherLICENSE
CABV3722178OtherDEA
F79189Medicare UPIN