Provider Demographics
NPI:1316705130
Name:VELASQUEZ, CYNDY ADRIANA (MS, ATC)
Entity type:Individual
Prefix:
First Name:CYNDY
Middle Name:ADRIANA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7681 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1902
Mailing Address - Country:US
Mailing Address - Phone:714-791-5057
Mailing Address - Fax:
Practice Address - Street 1:700 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1843
Practice Address - Country:US
Practice Address - Phone:717-547-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2000050124207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine