Provider Demographics
NPI:1881829083
Name:VELASQUEZ, MONICA
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5745
Mailing Address - Country:US
Mailing Address - Phone:562-846-6417
Mailing Address - Fax:323-582-1103
Practice Address - Street 1:10440 PARAMOUNT BLVD APT G269
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2345
Practice Address - Country:US
Practice Address - Phone:562-846-6417
Practice Address - Fax:323-582-1103
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$Medicare UPIN
CA$$$$$$$$$Medicare PIN