Provider Demographics
NPI:1902134539
Name:VELAZQUEZ PERKINS, SANDRA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:VELAZQUEZ PERKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-4823
Mailing Address - Country:US
Mailing Address - Phone:951-849-1950
Mailing Address - Fax:951-849-0080
Practice Address - Street 1:330 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4823
Practice Address - Country:US
Practice Address - Phone:951-849-1950
Practice Address - Fax:951-849-0080
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 20621OtherCA PA-C LICENSE NUMBER