Provider Demographics
NPI:1649912270
Name:VELASCO, ALYSSA J (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 LOS PUEBLOS PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4451
Mailing Address - Country:US
Mailing Address - Phone:505-231-0244
Mailing Address - Fax:
Practice Address - Street 1:MSC09 5030, 1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-8244
Practice Address - Fax:505-272-4639
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program