Provider Demographics
NPI:1821362567
Name:VELAZQUEZ GONZALEZ, MEGAN LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEE
Last Name:VELAZQUEZ GONZALEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:LEE
Other - Last Name:VELAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:11481 HARRISBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3963
Mailing Address - Country:US
Mailing Address - Phone:562-879-9624
Mailing Address - Fax:
Practice Address - Street 1:2683 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2610
Practice Address - Country:US
Practice Address - Phone:562-997-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine