Provider Demographics
NPI:1104885094
Name:VELASCO, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-3302
Mailing Address - Country:US
Mailing Address - Phone:831-757-8689
Mailing Address - Fax:831-757-3721
Practice Address - Street 1:950 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2150
Practice Address - Country:US
Practice Address - Phone:831-757-6237
Practice Address - Fax:831-757-8458
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45395207Q00000X
CAG51394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA93058Medicare UPIN