Provider Demographics
NPI:1700813672
Name:VELEZ, MIGUEL A (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W LA PALMA AVE
Mailing Address - Street 2:STE 705
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2814
Mailing Address - Country:US
Mailing Address - Phone:714-772-6701
Mailing Address - Fax:714-772-5240
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:STE 705
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:714-772-6701
Practice Address - Fax:714-772-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0000190Medicaid
CAWG50906AMedicare PIN
CAGR0000190Medicaid