Provider Demographics
NPI:1871262386
Name:VELAZQUEZ, ADRIAN ULYSSES (BA)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ULYSSES
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 E WORKMAN ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3500
Mailing Address - Country:US
Mailing Address - Phone:626-331-0335
Mailing Address - Fax:
Practice Address - Street 1:271 E WORKMAN ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3500
Practice Address - Country:US
Practice Address - Phone:626-331-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician