Provider Demographics
NPI:1902597602
Name:VELASQUEZ, ANGELICA ANDAYA
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:ANDAYA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANGELICA
Other - Middle Name:PINTOR
Other - Last Name:ANDAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:910 HUTTENBERG CT
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5749
Mailing Address - Country:US
Mailing Address - Phone:253-380-3216
Mailing Address - Fax:
Practice Address - Street 1:VA SPARK M. MATSUNAGA
Practice Address - Street 2:459 PATTERSON RD
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1522
Practice Address - Country:US
Practice Address - Phone:253-380-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709551163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse