Provider Demographics
NPI:1619790680
Name:VELASCO, GIOVANI (LCM)
Entity type:Individual
Prefix:
First Name:GIOVANI
Middle Name:
Last Name:VELASCO
Suffix:
Gender:X
Credentials:LCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 S VILLAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3696
Mailing Address - Country:US
Mailing Address - Phone:909-599-8222
Mailing Address - Fax:
Practice Address - Street 1:957 S VILLAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3696
Practice Address - Country:US
Practice Address - Phone:909-599-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management