Provider Demographics
NPI:1063107464
Name:VELEZ, ELIZABETH ALEXANDRA (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALEXANDRA
Last Name:VELEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 SWARTHMORE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1527
Mailing Address - Country:US
Mailing Address - Phone:818-484-1358
Mailing Address - Fax:
Practice Address - Street 1:711 W COLLEGE ST STE 328
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3177
Practice Address - Country:US
Practice Address - Phone:213-482-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily