Provider Demographics
NPI:1841347010
Name:VELASQUEZ, MICHELLE EMIKO (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EMIKO
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PURPLE SAGE LN
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3946
Mailing Address - Country:US
Mailing Address - Phone:818-378-7642
Mailing Address - Fax:818-378-7642
Practice Address - Street 1:151 PURPLE SAGE LN
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3946
Practice Address - Country:US
Practice Address - Phone:818-378-7642
Practice Address - Fax:818-378-7642
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6225171100000X
HI669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06832ZOtherUNITEDHEALTHCARE