Provider Demographics
NPI:1275257008
Name:RIOS VELASQUEZ, LINDA C (R1478870822)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:RIOS VELASQUEZ
Suffix:
Gender:F
Credentials:R1478870822
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 SIMPATICO CT.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154
Mailing Address - Country:US
Mailing Address - Phone:619-530-2602
Mailing Address - Fax:
Practice Address - Street 1:1465 30TH ST STE K
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3497
Practice Address - Country:US
Practice Address - Phone:619-428-1000
Practice Address - Fax:619-428-1091
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist