Provider Demographics
NPI:1932318656
Name:VELASQUEZ, RAMONA LISA (CASII)
Entity Type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:LISA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:CASII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 S MARTIN L KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-5345
Mailing Address - Country:US
Mailing Address - Phone:559-265-4800
Mailing Address - Fax:
Practice Address - Street 1:2772 S. MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706
Practice Address - Country:US
Practice Address - Phone:559-265-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII7041214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)