Provider Demographics
NPI:1215437686
Name:VELASCO, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VELASCO
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 1:6524 FRIENDS AVE APT B
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4588
Mailing Address - Country:US
Mailing Address - Phone:562-968-7859
Mailing Address - Fax:
Practice Address - Street 1:6524 FRIENDS AVE APT B
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4588
Practice Address - Country:US
Practice Address - Phone:562-968-7859
Practice Address - Fax:562-968-7859
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40044225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist