Provider Demographics
NPI:1225218217
Name:VELAZQUEZ, BRANDON BENJAMIN
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:BENJAMIN
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2530
Mailing Address - Country:US
Mailing Address - Phone:209-238-9436
Mailing Address - Fax:209-569-0676
Practice Address - Street 1:621 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2530
Practice Address - Country:US
Practice Address - Phone:209-238-9436
Practice Address - Fax:209-569-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor