Provider Demographics
NPI:1659705036
Name:VELOZ, ISAAC RICHARD (CMT)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:RICHARD
Last Name:VELOZ
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4592 TUTTLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2031
Mailing Address - Country:US
Mailing Address - Phone:916-517-5606
Mailing Address - Fax:
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:#610
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4385
Practice Address - Country:US
Practice Address - Phone:916-259-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist