Provider Demographics
NPI:1841563673
Name:LUIS H. VELOSA M.D., INC.
Entity Type:Organization
Organization Name:LUIS H. VELOSA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-733-8416
Mailing Address - Street 1:1029 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4117
Mailing Address - Country:US
Mailing Address - Phone:559-733-8416
Mailing Address - Fax:559-636-7874
Practice Address - Street 1:1029 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4117
Practice Address - Country:US
Practice Address - Phone:559-733-8416
Practice Address - Fax:559-636-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA299112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25907Medicare UPIN
CA00A299110Medicare PIN