Provider Demographics
NPI:1598547572
Name:VELOSO, RIGOBERTO MANUEL (DDS)
Entity type:Individual
Prefix:
First Name:RIGOBERTO MANUEL
Middle Name:
Last Name:VELOSO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RIGOBERTO MANUEL
Other - Middle Name:OUANO
Other - Last Name:VELOSO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2125 AMADOR PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6132
Mailing Address - Country:US
Mailing Address - Phone:407-721-4560
Mailing Address - Fax:
Practice Address - Street 1:8204 DELTA SHORES CIR S STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95832-9111
Practice Address - Country:US
Practice Address - Phone:916-277-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist