Provider Demographics
NPI:1063887222
Name:ANTERO VELEZ MD, INC
Entity type:Organization
Organization Name:ANTERO VELEZ MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTERO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-310-3293
Mailing Address - Street 1:21301 ERWIN ST UNIT 237
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3789
Mailing Address - Country:US
Mailing Address - Phone:818-310-3293
Mailing Address - Fax:
Practice Address - Street 1:21301 ERWIN ST UNIT 237
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3789
Practice Address - Country:US
Practice Address - Phone:818-310-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30678261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30678Medicaid
CAA30678Medicaid
A26187Medicare UPIN