Provider Demographics
NPI:1366597643
Name:VELARDE, JUAN FERNANDO (CAARR CERTIFICATE)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:FERNANDO
Last Name:VELARDE
Suffix:
Gender:M
Credentials:CAARR CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 C ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2099
Mailing Address - Country:US
Mailing Address - Phone:760-351-0168
Mailing Address - Fax:
Practice Address - Street 1:1295 W STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2881
Practice Address - Country:US
Practice Address - Phone:760-353-0763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)