Provider Demographics
NPI:1760581631
Name:VELAZQUEZ, KEI JULIA (CNM)
Entity Type:Individual
Prefix:
First Name:KEI
Middle Name:JULIA
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5540
Mailing Address - Country:US
Mailing Address - Phone:707-964-1251
Mailing Address - Fax:707-961-2722
Practice Address - Street 1:855 SEQUOIA CIR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5466
Practice Address - Country:US
Practice Address - Phone:707-964-1251
Practice Address - Fax:707-961-2722
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11789363L00000X
CA1448176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11789OtherNURSE PRACTITIONER
CA1448OtherNURSE MIDWIFE
CACMM71141FMedicaid