Provider Demographics
NPI:1740453414
Name:VELASQUEZ, GEORGE RAMIREZ (INDEPENDENT DUTY HM)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RAMIREZ
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:RAMIREZ
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HM1/IDC/E-6
Mailing Address - Street 1:5553 BAILEYA AVE
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-1321
Mailing Address - Country:US
Mailing Address - Phone:760-367-5443
Mailing Address - Fax:
Practice Address - Street 1:3RDLARBN, H&S COMPANY, MEDICAL BAS
Practice Address - Street 2:MCGACC 29 PALMS, 1STMARDIVDET
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-1321
Practice Address - Country:US
Practice Address - Phone:760-830-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical