Provider Demographics
NPI:1821637208
Name:VELASQUEZ, LISA MADRID (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MADRID
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 S FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-8501
Mailing Address - Country:US
Mailing Address - Phone:661-331-7387
Mailing Address - Fax:
Practice Address - Street 1:3300 BUENA VISTA RD STE K
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9750
Practice Address - Country:US
Practice Address - Phone:661-664-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013557363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care