Provider Demographics
NPI:1225878549
Name:VELASQUEZ, JACQUELINE (BS)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CRESTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3585
Mailing Address - Country:US
Mailing Address - Phone:469-235-1767
Mailing Address - Fax:
Practice Address - Street 1:1111 W MOCKINGBIRD LN STE 480
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5062
Practice Address - Country:US
Practice Address - Phone:972-489-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator