Provider Demographics
NPI:1114409190
Name:TERAN-VELASQUEZ, ROXANA
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:TERAN-VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4168 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4633
Mailing Address - Country:US
Mailing Address - Phone:323-379-7892
Mailing Address - Fax:
Practice Address - Street 1:50 W LEMON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5112
Practice Address - Country:US
Practice Address - Phone:310-227-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1267451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical