Provider Demographics
NPI:1972702322
Name:VELASCO, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:VELASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6980 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-6635
Mailing Address - Country:US
Mailing Address - Phone:408-846-4727
Mailing Address - Fax:408-842-0757
Practice Address - Street 1:6980 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6635
Practice Address - Country:US
Practice Address - Phone:408-846-4727
Practice Address - Fax:408-842-0757
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health