Provider Demographics
NPI:1942782230
Name:VELASQUEZ, HEAVEN LEIGH I
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:LEIGH
Last Name:VELASQUEZ
Suffix:I
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 1:20823 E MESARICA RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3311
Mailing Address - Country:US
Mailing Address - Phone:626-214-6492
Mailing Address - Fax:
Practice Address - Street 1:5601 ARNOLD RD FL 102
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7726
Practice Address - Country:US
Practice Address - Phone:925-248-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-03
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician