Provider Demographics
NPI:1689778235
Name:VELASCO, OSCAR LOPEZ (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:LOPEZ
Last Name:VELASCO
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 1:341 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-4109
Mailing Address - Country:US
Mailing Address - Phone:559-781-4007
Mailing Address - Fax:559-783-9454
Practice Address - Street 1:560 W PUTNAM AVE
Practice Address - Street 2:#5
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-781-4007
Practice Address - Fax:559-783-9454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA388131Medicaid
A28730Medicare UPIN
CAOOA388131Medicaid