Provider Demographics
NPI:1992263677
Name:VELASCO, ROMINA CORAZON JIMENEZ (PMH NP)
Entity type:Individual
Prefix:
First Name:ROMINA CORAZON
Middle Name:JIMENEZ
Last Name:VELASCO
Suffix:
Gender:F
Credentials:PMH NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6914
Mailing Address - Country:US
Mailing Address - Phone:562-346-1100
Mailing Address - Fax:562-961-7606
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 600
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6914
Practice Address - Country:US
Practice Address - Phone:562-346-1100
Practice Address - Fax:562-961-7606
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95022464363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health