Provider Demographics
NPI:1285105841
Name:VELASCO, CRISTITO S (DOCTOR OF EDUCATION)
Entity type:Individual
Prefix:DR
First Name:CRISTITO
Middle Name:S
Last Name:VELASCO
Suffix:
Gender:M
Credentials:DOCTOR OF EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 SW CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1600
Mailing Address - Country:US
Mailing Address - Phone:541-992-0709
Mailing Address - Fax:503-746-6849
Practice Address - Street 1:12655 SW CENTER ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1600
Practice Address - Country:US
Practice Address - Phone:541-992-0709
Practice Address - Fax:503-746-6849
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201212038376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR152372Medicaid