Provider Demographics
NPI:1245866565
Name:VELASQUEZ, JOSHUA ADOLFO
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:ADOLFO
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 N RIDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4302
Mailing Address - Country:US
Mailing Address - Phone:424-666-7108
Mailing Address - Fax:
Practice Address - Street 1:849 N RIDGEWOOD PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-4302
Practice Address - Country:US
Practice Address - Phone:424-666-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374700000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No374700000XNursing Service Related ProvidersTechnician