Provider Demographics
NPI:1588275903
Name:VELASCO, CARMEN YAZMIN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:YAZMIN
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6863 FARMALL WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3418
Mailing Address - Country:US
Mailing Address - Phone:714-396-5307
Mailing Address - Fax:
Practice Address - Street 1:1820 UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5355
Practice Address - Country:US
Practice Address - Phone:951-955-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker