Provider Demographics
NPI:1013138239
Name:VELASQUEZ, MATTHEW MICHAEL
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:MICHAEL
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:25400 OAK ST
Mailing Address - Street 2:APT. #4
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2262
Mailing Address - Country:US
Mailing Address - Phone:310-766-7931
Mailing Address - Fax:
Practice Address - Street 1:20710 LEAPWOOD AVE
Practice Address - Street 2:STE. C
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3642
Practice Address - Country:US
Practice Address - Phone:310-324-0447
Practice Address - Fax:310-324-0147
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH704020OtherMEDI-CAL