Provider Demographics
NPI:1285967562
Name:VELEZ, MARC DANIEL (LAC)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:DANIEL
Last Name:VELEZ
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:5728 MCFARLANE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5743
Mailing Address - Country:US
Mailing Address - Phone:415-513-5671
Mailing Address - Fax:415-418-3491
Practice Address - Street 1:315 E COTATI AVE
Practice Address - Street 2:SUITE E
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-4475
Practice Address - Country:US
Practice Address - Phone:707-242-6812
Practice Address - Fax:415-418-3491
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2014-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA13323171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist