Provider Demographics
NPI:1205666450
Name:VELAZQUEZ, FERNANDO ANGEL I
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ANGEL
Last Name:VELAZQUEZ
Suffix:I
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 1:12122 GAY RIO TER
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-4915
Mailing Address - Country:US
Mailing Address - Phone:619-340-9853
Mailing Address - Fax:
Practice Address - Street 1:252 FLOWERDALE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7332
Practice Address - Country:US
Practice Address - Phone:619-340-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst