Provider Demographics
NPI:1619228293
Name:VELASQUEZ-RODARTE, VERONICA
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
Last Name:VELASQUEZ-RODARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:360 S IDAHO ST APT 13
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5273
Mailing Address - Country:US
Mailing Address - Phone:805-503-9456
Mailing Address - Fax:
Practice Address - Street 1:4484 FOURTH ST.
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:CA
Practice Address - Zip Code:93434
Practice Address - Country:US
Practice Address - Phone:805-503-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health