Provider Demographics
NPI:1720370893
Name:VELAZQUEZ, AMANDA ERIN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ERIN
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 LOS COCHES ST
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5423
Mailing Address - Country:US
Mailing Address - Phone:408-945-2933
Mailing Address - Fax:
Practice Address - Street 1:589 LOS COCHES ST
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5423
Practice Address - Country:US
Practice Address - Phone:408-945-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics