Provider Demographics
NPI:1982007068
Name:VELAZQUEZ, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:VELAZQUEZ
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 1:9521 LAUREL CANYON BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4278
Mailing Address - Country:US
Mailing Address - Phone:818-492-6610
Mailing Address - Fax:
Practice Address - Street 1:9521 LAUREL CANYON BLVD APT 1
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-4278
Practice Address - Country:US
Practice Address - Phone:818-492-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program