Provider Demographics
NPI:1336911205
Name:VELASQUEZ, LUIS DAVID
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:DAVID
Last Name:VELASQUEZ
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 1:13120 PURCHE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1643
Mailing Address - Country:US
Mailing Address - Phone:310-694-1286
Mailing Address - Fax:
Practice Address - Street 1:5000 W SUNSET BLVD STE 610
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5863
Practice Address - Country:US
Practice Address - Phone:323-671-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator