Provider Demographics
NPI:1689620460
Name:VELASCO, DAVID L JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:VELASCO
Suffix:JR
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:825 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382
Practice Address - Country:US
Practice Address - Phone:209-667-4200
Practice Address - Fax:209-669-2377
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66836207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A668360Medicaid
H33539Medicare UPIN
CA00A668366Medicare PIN
CA00A668365Medicare PIN
CABN160Medicare PIN
CA00A668360Medicaid
CAP00695234Medicare PIN