Provider Demographics
NPI:1881810141
Name:VELAZQUEZ, EDWARD GEORGE (PA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:GEORGE
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:7777 MILLIKEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6780
Mailing Address - Country:US
Mailing Address - Phone:909-948-8050
Mailing Address - Fax:909-948-8061
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-948-8050
Practice Address - Fax:909-948-8061
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-08-18
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Provider Licenses
StateLicense IDTaxonomies
CA10723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant